Healthcare Provider Details

I. General information

NPI: 1801094347
Provider Name (Legal Business Name): MARCO TODD CARINO MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

2524 NE 9TH ST
FORT LAUDERDALE FL
33304-3525
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone: 206-579-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 23357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: