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

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 and National Provider Directory roles.

• Maxca Inc

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

  • 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 Centre of West FL, PA
• Dental Contracted Services PA
• Dental Eexperts of Florida
• Dental Health Services Bradenton PA
• 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.