Provider Demographics
NPI:1205997137
Name:LIVE WELL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:LIVE WELL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-842-5522
Mailing Address - Street 1:623 RIVER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3267
Mailing Address - Country:US
Mailing Address - Phone:732-842-5522
Mailing Address - Fax:732-842-2711
Practice Address - Street 1:623 RIVER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3267
Practice Address - Country:US
Practice Address - Phone:732-842-5522
Practice Address - Fax:732-842-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicare UPIN
NJ093640Medicare ID - Type Unspecified