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NPI Code Detail

MEDICARE: MR. PABLO EDGARDO DER BOGHOSSIAN P.T.

MEDICARE: MR. PABLO EDGARDO DER BOGHOSSIAN P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical Therapist
22251S0007XSports Physical TherapistPT13467
32251X0800XOrthopedic Physical Therapist
4225100000XPhysical TherapistPT0013467FL

General Provider Information

NPI Number : 1922158484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PABLO EDGARDO DER BOGHOSSIAN P.T.
Provider Business Mailing Address
First Line : PO BOX 5887
Second Line :
City : SARASOTA
State : FL
Zip : 34277-5887
Country : US
Telephone Number : 941-870-7473
Fax Number : 941-870-4915
Provider Business Practice Location Address
First Line : 1800 CORTEZ RD W STE C
Second Line :
City : BRADENTON
State : FL
Zip : 34207-1335
Country : US
Telephone Number : 941-870-7473
Fax Number : 941-870-4915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 06/22/2022

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