Provider Demographics
NPI:1023113982
Name:STINSON, PABLO (PT)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:STINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NW 65TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2480
Mailing Address - Country:US
Mailing Address - Phone:954-547-4697
Mailing Address - Fax:
Practice Address - Street 1:9699 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4001
Practice Address - Country:US
Practice Address - Phone:954-344-7771
Practice Address - Fax:954-344-6475
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106687Medicare ID - Type Unspecified