Healthcare Provider Details

I. General information

NPI: 1225976152
Provider Name (Legal Business Name): AUDRIANNA BORNAMANN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 OAKWOOD BLVD
DEARBORN MI
48124-5025
US

IV. Provider business mailing address

12121 CAVELL ST
LIVONIA MI
48150-5317
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-7977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: