Healthcare Provider Details

I. General information

NPI: 1396764874
Provider Name (Legal Business Name): KYLE BOROWITZ P.T. AND O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S PIONEER RD # 100
FOND DU LAC WI
54935-3871
US

IV. Provider business mailing address

103 S PIONEER RD # 100
FOND DU LAC WI
54935-3871
US

V. Phone/Fax

Practice location:
  • Phone: 920-922-7776
  • Fax: 920-922-2938
Mailing address:
  • Phone: 920-922-7776
  • Fax: 920-922-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2895-026
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9887-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: