Provider Demographics
NPI:1427770767
Name:LIVINGSTON, MAXIE BRAUN (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MAXIE
Middle Name:BRAUN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N BEEBE ST APT 2096
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7691
Mailing Address - Country:US
Mailing Address - Phone:602-617-1285
Mailing Address - Fax:
Practice Address - Street 1:2700 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5399
Practice Address - Country:US
Practice Address - Phone:480-472-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0095402255A2300X
AZ390200000X
20000535162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program