Provider Demographics
NPI:1861478273
Name:PESCOD, LAURA L (PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:PESCOD
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 KIRKWOOD TER N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1613
Mailing Address - Country:US
Mailing Address - Phone:727-644-4894
Mailing Address - Fax:727-821-3395
Practice Address - Street 1:545 KIRKWOOD TER N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1613
Practice Address - Country:US
Practice Address - Phone:727-644-4894
Practice Address - Fax:727-821-3395
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 168902251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885755500Medicaid
FL811502800Medicaid