Provider Demographics
NPI:1104473529
Name:LIVINGSTON, KELSEA E (DPT)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:E
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSEA
Other - Middle Name:
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-934-3667
Practice Address - Street 1:4700 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3465
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-934-3667
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5472225100000X
MS225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist