Provider Demographics
NPI:1629523345
Name:SIVITER, LAURA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:SIVITER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:CAZELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8045 SPYGLASS HILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8567
Mailing Address - Country:US
Mailing Address - Phone:321-622-4139
Mailing Address - Fax:
Practice Address - Street 1:8045 SPYGLASS HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8567
Practice Address - Country:US
Practice Address - Phone:321-622-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist