=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609744754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN CARABALI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 NW PEACOCK BLVD STE 104
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-2274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-344-8254
-----------------------------------------------------
Fax | 772-673-5807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2627 FILLMORE ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-822-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA24827
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------