Provider Demographics
NPI:1497264204
Name:BOTERO, HUGO (DPT)
Entity Type:Individual
Prefix:MR
First Name:HUGO
Middle Name:
Last Name:BOTERO
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 1:5651 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4128
Mailing Address - Country:US
Mailing Address - Phone:954-496-4820
Mailing Address - Fax:
Practice Address - Street 1:100 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1703
Practice Address - Country:US
Practice Address - Phone:954-530-8289
Practice Address - Fax:754-301-7942
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT33008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist