Healthcare Provider Details

I. General information

NPI: 1043983034
Provider Name (Legal Business Name): CHRISTIAN BORES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVENUE I NE
WINTER HAVEN FL
33881-4143
US

IV. Provider business mailing address

4850 S DOSSEY RD
LAKELAND FL
33811-1503
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: