Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 004045 | NY |
NPI | 1023154275 |
---|---|
Provider Name | Deborah Lynn Borlaug |
First Address | Depew, NY 14043-1051 |
Second Address | Batavia, NY 14020-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |