Provider Demographics
NPI:1265461602
Name:RESTIERI, LAWRENCE THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:THOMAS
Last Name:RESTIERI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:386-454-3941
Mailing Address - Fax:386-454-4066
Practice Address - Street 1:18245 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-9621
Practice Address - Country:US
Practice Address - Phone:386-454-3941
Practice Address - Fax:386-454-4066
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV18929Medicare UPIN