Provider Demographics
NPI:1437381092
Name:TABO, MICHAEL TABLIZO (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TABLIZO
Last Name:TABO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9260
Mailing Address - Country:US
Mailing Address - Phone:321-841-3760
Mailing Address - Fax:321-841-3232
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:321-841-3760
Practice Address - Fax:321-841-3232
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33761225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3437OtherSTATE OF NV PT LICENSE NUMBER
FLPT-33761OtherSTATE OF FL PT LICENSE NUMBER
TX1228590OtherSTATE OF TX PT LICENSE NUMBER
FLCK126ZMedicare PIN