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General NPI Number Information
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NPI Number | 1114074234
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC PHYSICAL THERAPY, LTD.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7119 MAPLE LN
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City | HORACE
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State | ND
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Zip | 58047-4714
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Country | US
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Telephone | 701-281-1864
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Fax | 701-281-1924
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Provider Business Mailing Address
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Address Line | 7119 MAPLE LN
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City | HORACE
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State | ND
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Zip | 58047-4714
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Country | US
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Telephone | 701-281-1864
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Fax | 701-281-1924
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | MR. BRIAN ALLEN BORCHARDT
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Credential | PT
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Telephone | 701-281-1864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | ND
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