Healthcare Provider Details

I. General information

NPI: 1598283996
Provider Name (Legal Business Name): REBECC MOHL BORER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 COLLEGE DR
ALBANY GA
31705-2717
US

IV. Provider business mailing address

504 COLLEGE DR
ALBANY GA
31705-2717
US

V. Phone/Fax

Practice location:
  • Phone: 229-886-2268
  • Fax:
Mailing address:
  • Phone: 229-430-1903
  • Fax: 229-430-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT001721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: