Lara V Carballo, RPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT13675 Issued in FL

Practice address

2739 Upper Park Rd
Orlando, FL 32814-6148

Phone

(407) 443-9696

Fax

(407) 754-2624

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Lara Bouffard Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124229786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2739 UPPER PARK RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146148",
            "telephone_number": "407-443-9696",
            "fax_number": "407-754-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2739 UPPER PARK RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146148",
            "telephone_number": "407-443-9696",
            "fax_number": "407-754-2624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBALLO",
        "first_name": "LARA",
        "middle_name": "V",
        "name_prefix": "Mrs.",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT13675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARA",
            "last_name": "BOUFFARD",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Francis Raymund Rivero Carandang, M.D.
• Juanita Carbajal
• Amanda Carballea
• Azalia Carballo
• Kamila De la Caridad Carballo
• Andrew Carbone, MD
• Kimberly Carbone
• Olivia Carbone, PA
• Tejah Carbone, LCSW
• Nicole Carbonelli Rosa

• Pediatric Physical Therapist in Orlando, FL
• Providers in Orlando, FL by specialty
• Pediatric Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.