MEDICARE: GARY BORNAK MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT008598L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205822764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BORNAK MSPT

Provider Business Mailing Address
First Line	:	4609 EASY ST
Second Line	:
City	:	WEST MIFFLIN
State	:	PA
Zip	:	15122-1966
Country	:	US
Telephone Number	:	412-462-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	2279B MAIN ST
Second Line	:
City	:	MUNHALL
State	:	PA
Zip	:	15120-2652
Country	:	US
Telephone Number	:	412-461-1191
Fax Number	:	412-462-1182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	12/05/2007

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Directions to “ GARY BORNAK MSPT” Practice Location

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