Provider Demographics
NPI:1770683583
Name:STABLE, JOSE JOAQUIN (PT,PTA,LMT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JOAQUIN
Last Name:STABLE
Suffix:
Gender:M
Credentials:PT,PTA,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2413
Mailing Address - Country:US
Mailing Address - Phone:561-738-6691
Mailing Address - Fax:561-777-7878
Practice Address - Street 1:2602 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2413
Practice Address - Country:US
Practice Address - Phone:561-738-6691
Practice Address - Fax:561-777-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18956225200000X
FLMA35991225700000X
FLPT32333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist