Individual
CARLOS FABRICIO BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
146 SW ORTHOPEDIC CT, LAKE CITY, FL 32024-0672
(386) 755-9215
(386) 755-6469
Mailing address
4500 W NEWBERRY RD, GAINESVILLE, FL 32607-2245
(352) 336-6000
(352) 332-0799
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA24839
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA24839
PTA LICENSE
FL
Enumeration date
05/13/2014
Last updated
02/19/2015
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