Healthcare Provider Details

I. General information

NPI: 1083282271
Provider Name (Legal Business Name): ALEXANDER MICHAEL BORES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9512 DORCHESTER RD STE 140
SUMMERVILLE SC
29485-4305
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 843-695-7970
  • Fax: 843-695-7971
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-921-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10635
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: