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General NPI Number Information
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NPI Number | 1659186328
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Entity Type | Individual
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Provider Name | MICHAEL EHAB BOULOS DPT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 4401 S HOPKINS AVE STE 105
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City | TITUSVILLE
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State | FL
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Zip | 32780-6679
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Country | US
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Telephone | 321-383-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 FOLIAGE OAK TER
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City | OVIEDO
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State | FL
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Zip | 32766-7022
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Country | US
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Telephone | 321-222-8756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT42833
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License Number State | FL
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