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 1:159 WOODED VINE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-0039
Mailing Address - Country:US
Mailing Address - Phone:773-787-7951
Mailing Address - Fax:
Practice Address - Street 1:420 TRADITION LN
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6350
Practice Address - Country:US
Practice Address - Phone:773-787-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT-33761OtherSTATE OF FL PT LICENSE NUMBER
NV3437OtherSTATE OF NV PT LICENSE NUMBER
TX1228590OtherSTATE OF TX PT LICENSE NUMBER
FLCK126ZMedicare PIN