Healthcare Provider Details

I. General information

NPI: 1124782495
Provider Name (Legal Business Name): DARA MELISSA BORDMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GLENMERE COVE RD
GOSHEN NY
10924-6059
US

IV. Provider business mailing address

5 MELISSA CT
WARWICK NY
10990-1051
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-4740
  • Fax:
Mailing address:
  • Phone: 845-699-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055456
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: