Angela Maria Restivo, LMT

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

MA85843 Issued in FL

Practice address

2180 A1A S
St Augustine, FL 32080-6591

Phone

(443) 257-3085

NPI assigned

Sep 21, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505952000000",
    "number": "1699284661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 2ND ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806369",
            "telephone_number": "443-257-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 A1A S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806591",
            "telephone_number": "443-257-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESTIVO",
        "first_name": "ANGELA",
        "middle_name": "MARIA",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "FL",
            "license": "MA85843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Neuromusculoskeletal Medicine) Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.