Provider Demographics
NPI:1346750312
Name:SARTINO, TERESE A (LMT)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:A
Last Name:SARTINO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 WATER POPPY TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5124
Mailing Address - Country:US
Mailing Address - Phone:815-262-9874
Mailing Address - Fax:
Practice Address - Street 1:11503 WATER POPPY TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5124
Practice Address - Country:US
Practice Address - Phone:815-262-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001278225700000X
WI10623-146225700000X
FLMA79618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist