Healthcare Provider Details

I. General information

NPI: 1093664104
Provider Name (Legal Business Name): CAROLINE BORDNER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

310 6TH AVE APT 18
SAN FRANCISCO CA
94118-2347
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: