| Doctor Name: | DR. MICHAEL ROBERT DE RIESTHAL |
| NPI Number: | 1124103981 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D |
| License Number: | SA 6898 |
| Business Practice Address: | 1601 Sw Archer Rd Neurology Service (127) Gainesville, FL - 326081135 |
| Business Phone Number: | 3523761611 |
| Business Fax Number: | |
| Mailing Address: | 9488 Nw 24th Rd, GAINESVILLE |
| State: | FL |
| Postal Code: | 326069203 |
| Phone Number: | 3523311786 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA 6898 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |