Provider Demographics
NPI:1275562183
Name:BERTOLINO, LAWRENCE A (PT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:BERTOLINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 BERNBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240
Mailing Address - Country:US
Mailing Address - Phone:941-350-0006
Mailing Address - Fax:941-379-8684
Practice Address - Street 1:5023 RINGWOOD MDW
Practice Address - Street 2:BLDG F
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2035
Practice Address - Country:US
Practice Address - Phone:941-360-9706
Practice Address - Fax:941-360-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2045Medicare PIN