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General NPI Number Information
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NPI Number | 1578273322
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Entity Type | Individual
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Provider Name | ELLIOTT BORGEN DPT
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Gender | Male
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 10099 SEMINOLE BLVD STE A5
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City | SEMINOLE
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State | FL
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Zip | 33772-2540
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Country | US
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Telephone | 727-399-8226
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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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 |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27957
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT42593
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT016129
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License Number State | GA
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