Provider Demographics
NPI:1922210970
Name:LIVRERI, KERYNNE (MS, PT, DPT)
Entity Type:Individual
Prefix:
First Name:KERYNNE
Middle Name:
Last Name:LIVRERI
Suffix:
Gender:F
Credentials:MS, PT, DPT
Other - Prefix:
Other - First Name:KERYNNE
Other - Middle Name:
Other - Last Name:LIVRERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PT, DPT
Mailing Address - Street 1:11910 WHISTLING WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11910 WHISTLING WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2049
Practice Address - Country:US
Practice Address - Phone:973-632-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0866200225100000X
FL24262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist