Provider Demographics
NPI:1841822632
Name:LIVEZEY, ROBERT WALTER (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:LIVEZEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WALTER WARD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1285
Mailing Address - Country:US
Mailing Address - Phone:443-512-8337
Mailing Address - Fax:
Practice Address - Street 1:136 S PHILADELPHIA BLVD STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3203
Practice Address - Country:US
Practice Address - Phone:443-512-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist