Provider Demographics
NPI:1306083548
Name:MESSINA, LAURIE (LMT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MESSINA
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 1:133 W 6TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7621
Mailing Address - Country:US
Mailing Address - Phone:352-729-2113
Mailing Address - Fax:
Practice Address - Street 1:122 S GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6017
Practice Address - Country:US
Practice Address - Phone:352-729-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 14013174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist