Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1121 | ND |
N | 2251P0200X | Physical Therapist - Pediatrics | 6775 | MN |
NPI | 1053468223 |
---|---|
Provider Name | Mr. Brian Allen Borchardt |
First Address | Horace, ND 58047-4714 |
Second Address | Horace, ND 58047-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23319 | ND BLUE CROSS BLUE SHIELD (01) | ND |
51319 | (05) | ND |
64-05520 | AETNA (01) | |
64-05520 | MEDICA, UNITED HEALTHCARE (01) | |
821945 | AMERICAS PPO (01) | |
9075049 | PRIVATE HEALTHCARE SYSTEM (01) | |
HP50726 | HEALTH PARTNERS (01) |