Healthcare Provider Details

I. General information

NPI: 1184461576
Provider Name (Legal Business Name): CHRISTOPHER BOLDRIN PTA, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S PINE ISLAND RD
DAVIE FL
33328-5933
US

IV. Provider business mailing address

5850 S PINE ISLAND RD
DAVIE FL
33328-5933
US

V. Phone/Fax

Practice location:
  • Phone: 954-800-5826
  • Fax: 954-708-1469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPTA32790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: