Pablo Edgardo Der Boghossian, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT0013467 Issued in FL

Practice address

1800 Cortez Rd W Ste C
Bradenton, FL 34207-1335

Phone

(941) 870-7473

Fax

(941) 870-4915

NPI assigned

Jan 10, 2007

Last updated

Jun 22, 2022By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• 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.

• Maxca Inc

  dba P.T. Management Solutions

  • Physical Therapist
  • Bradenton, FL
  • NPI 1669110474
  Medicare reassignment NPD Authorized official
• Maxider Corporation

  dba Excell Rehab

  • Sports Physical Therapist
  • Venice, FL
  • NPI 1780712539
  NPD (past) Authorized official

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1922158484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5887",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342775887",
            "telephone_number": "941-870-7473",
            "fax_number": "941-870-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 CORTEZ RD W STE C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071335",
            "telephone_number": "941-870-7473",
            "fax_number": "941-870-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DER BOGHOSSIAN",
        "first_name": "PABLO",
        "middle_name": "EDGARDO",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": "PT13467",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT0013467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Contracted Services PA (David Sundeen, DDS)
• Dental Eexperts of Florida
• Dental Health Services Bradenton PA
• Dentists on Cortez, P.a (Dentists on Cortez)
• Dillon James Depergola, DMD
• Michael Derakhshan
• Derek Earle Consulting
• Derek Earle Consulting
• Derek Earle Services LLC
• Derek Earle Services LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.