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Individual

ROBERT LOUIS BOUTOTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
401 W KENNEDY BLVD # I, TAMPA, FL 33606-1450
(813) 253-6264
(813) 257-7746
Mailing address
401 W KENNEDY BLVD # I, TAMPA, FL 33606-1450
(813) 253-6264
(813) 257-7746

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL3957
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2000011101
BOARD OF CERTIFICATION
01
36422
NATIONAL ATHLETIC TRAINERS ASSOCIATION
01
AL3957
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
06/12/2018
Last updated
06/12/2018
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