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 1:110 CUMBERLAND PARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8901
Mailing Address - Country:US
Mailing Address - Phone:904-863-6313
Mailing Address - Fax:
Practice Address - Street 1:110 CUMBERLAND PARK DR STE 204
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8901
Practice Address - Country:US
Practice Address - Phone:904-863-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT33008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist