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General NPI Number Information
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NPI Number | 1932875960
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Entity Type | Individual
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Provider Name | MICHAEL BORDONARO DPT
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Gender | Male
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1090 MERIDEN WATERBURY TPKE
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City | PLANTSVILLE
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State | CT
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Zip | 06479-2055
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Country | US
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Telephone | 203-272-8490
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MAPLE RD
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City | PORTLAND
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State | CT
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Zip | 06480-1730
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Country | US
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Telephone | 860-558-0484
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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 | 13253
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License Number State | CT
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