Physophorina livingstoni is found along the east coast of Africa. Its geographic distribution extends from South Africa in the south, into Mozambique, Malawi, Tanzania, and as far as Uganda in the north. There is also an outlying and unconfirmed record from Zambia. While its extent of occurrence (EOO) is ca 3.4 million km², its area of occupancy (AOO) is estimated to be between 72 and 3,500 km².
The population is considered to be severely fragmented with limited exchange between small and isolated subpopulations that maybe non-viable. The species has not been collected in the field since 1957. Although extensive surveys have not been conducted in much of its range, surveys in South Africa have failed to detect the species in over 60 years. This indicates that the species is likely to be extremely rare and declining in at least part of its range.