Provider Demographics
NPI:1770191124
Name:AGUILAR, CARLOS A (PTA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SPRINGDALE CIR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1539
Mailing Address - Country:US
Mailing Address - Phone:561-386-4006
Mailing Address - Fax:
Practice Address - Street 1:3111 W BOYNTON BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4613
Practice Address - Country:US
Practice Address - Phone:561-865-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA2350261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy