Marc Boults

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 26221 Issued in FL

Practice address

602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900

Phone

(863) 617-9400

Fax

(863) 688-9858

NPI assigned

Feb 16, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physical Therapy Clinic of Naples LLC

  • Physical Therapy Clinic/Center
  • Naples, FL
  • NPI 1770782815
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397692800000",
    "number": "1033416631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 VONDERBURG DR",
            "address_2": "SUITE 201",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115900",
            "telephone_number": "863-617-9400",
            "fax_number": "863-688-9858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 VONDERBURG DR",
            "address_2": "SUITE 201",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115900",
            "telephone_number": "863-617-9400",
            "fax_number": "863-688-9858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULTS",
        "first_name": "MARC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-16",
        "last_updated": "2014-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 26221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lynn Borowski, MOT, OTR/L
• Lori Marie Borowski, LDO
• Becca Boucher
• Kaymert Boucourt
• Delacy Boudreaux
• Elizabeth Layne Bowden, OTR/L
• Riley Rose Bowers, PA-C
• Brianna Michele Bowman, MD
• Richard Bowser, M.D.
• Erica Boyer

• Physical Therapist in Brandon, FL
• Providers in Brandon, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.