MEDICARE: MRS. SANDY KAY BORGESON PTA

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	225200000X	Physical Therapy Assistant	117156	MO

General Provider Information

NPI Number	:	1235122367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDY KAY BORGESON PTA

Provider Business Mailing Address
First Line	:	5811 N WAYNE AVE
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5459
Country	:	US
Telephone Number	:	816-454-5818
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 NE ANTIOCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2301
Country	:	US
Telephone Number	:	816-454-5818
Fax Number	:	816-454-5818

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	01/06/2008

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