Robert Louis Boutote, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL3957 Issued in FL

Practice address

401 W Kennedy Blvd # I
Tampa, FL 33606-1450

Phone

(813) 253-6264

Fax

(813) 257-7746

NPI assigned

Jun 12, 2018

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1508359845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W KENNEDY BLVD # I",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061450",
            "telephone_number": "813-253-6264",
            "fax_number": "813-257-7746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W KENNEDY BLVD # I",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061450",
            "telephone_number": "813-253-6264",
            "fax_number": "813-257-7746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTOTE",
        "first_name": "ROBERT",
        "middle_name": "LOUIS",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-12",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "AL3957",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF CERTIFICATION",
            "identifier": "2000011101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL ATHLETIC TRAINERS ASSOCIATION",
            "identifier": "36422",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Donald Bourguignon, D.C.
• Diane Bourlier, DO
• Carla Inez Bourne, M.D.
• Teri L Boutilier, SLP
• Derek J Boutin
• Allison McLeod Boutwell, LCSW
• Emanuel Michael Boutzoukas, PH.D.
• Rachel Iris Bouza More
• Demetrios Matheos Bouziotis
• Courtney Elise Bovee, M.D.

• Athletic Trainer in Tampa, FL
• Providers in Tampa, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.