Healthcare Provider Details

I. General information

NPI: 1639091259
Provider Name (Legal Business Name): EMMALYSE BORDIGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 FOURTH ST
NAVARRE FL
32566-7531
US

IV. Provider business mailing address

3217 COLLEGE CT APT F
GULF BREEZE FL
32563-3363
US

V. Phone/Fax

Practice location:
  • Phone: 850-204-8030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number34899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: