NPIMap

Organization Active NPI

Livingston Physical Therapy PC

  • Physical Therapist
  • Livingston, TX
National Provider Identifier
1215930326
Registry record updated Jan 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LIVINGSTON PHYSICAL THERAPY PC
Practice address
305 W Mill St
Livingston, TX 77351-3299
Phone
(936) 327-4084
Fax
(936) 327-1201
NPI assigned
May 23, 2005
Last updated
Jan 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jessie Clarke, DPTNPI 1811537921
Title
President, Owner/P.T.
Phone
(936) 327-4084

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

305 W Mill St
Livingston, TX 77351-3299

Mailing address

305 W Mill St
Livingston, TX 77351-3299
Phone (936) 327-4084

Other identifiers 3

IdentifierTypeStateIssuer
109663801MedicaidTX
0070HEOtherTXBCBS PAR PLAN
0070HEOtherTXBCBS PAR PLAN GROUP #

Other names 1

  • Vivian B. Ellis, LPT Livingston Physical Therapy Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040207000139 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9234022641 Receives reassigned benefits from 2 practitioners
Practice locations: Livingston, TX

National Provider Directory

National Provider Directory

Locations

305 W Mill St
Livingston, TX 77351
Phone (936) 327-4084

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769644800000",
    "number": "1215930326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W MILL ST",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773513299",
            "telephone_number": "936-327-4084",
            "fax_number": "936-327-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W MILL ST",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773513299",
            "telephone_number": "936-327-4084",
            "fax_number": "936-327-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTON PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "PRESIDENT, OWNER/P.T.",
        "authorized_official_telephone_number": "936-327-4084",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109663801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PAR PLAN",
            "identifier": "0070HE",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PAR PLAN GROUP #",
            "identifier": "0070HE",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vivian B. Ellis, LPT Livingston Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Livingston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.