Michael James Boully Jr., P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18461 Issued in FL

Practice address

1513 Sun City Center PLZ
Sun City Center, FL 33573-5390

Phone

(813) 634-6022

Fax

(813) 634-6053

NPI assigned

Mar 30, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

State licenses

Practice roles

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

• 3D Cardio Diagnostic Center PA

  • Other Specialist/Technologist
  • Plant City, FL
  • NPI 1154504363
  NPD (past)
• Premium Care Medical Associates Inc

  • Chiropractor
  • Plant City, FL
  • NPI 1780825547

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1134249592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 ROLLING VISTA LOOP",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335274268",
            "telephone_number": "813-759-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 SUN CITY CENTER PLZ",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335735390",
            "telephone_number": "813-634-6022",
            "fax_number": "813-634-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULLY",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_suffix": "Jr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT18461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rahul Prakash Bhandari, M.D.
• Tiffany A Bishop, PTA
• Andrew Bloomfield, M.D.
• Victoria Alice Boisselle, PA-C
• Anthony Michael Bonacci, PT, DPT
• Christina Bowens, APRN
• Angelita Bowers
• Sarah Bowers, OT, CHT
• Brandon Eye Associates PA
• Paul A. Breault, O.D.

• Physical Therapist in Sun City Center, FL
• Providers in Sun City Center, FL by specialty
• 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.