=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689603318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSH A BORGMEYER PT, DPT, MTC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 01/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13421 MANCHESTER RD STE 207
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-9759
-----------------------------------------------------
Fax | 888-898-5857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 690 S GEYER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-9759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2002015003
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------