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General NPI Number Information
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NPI Number | 1184655789
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Entity Type | Individual
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Provider Name | KATHY MARIE BORRELLI PT OMPT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 4801 FAIRWAY AVE
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-8009
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Country | US
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Telephone | 501-758-1300
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Fax | 501-758-1316
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Provider Business Mailing Address
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Address Line | 4801 FAIRWAY AVE
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7665
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Country | US
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Telephone | 501-758-1300
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Fax | 501-758-1316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 2839
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License Number State | AR
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