MEDICARE: DR. ANNA BORISSOW DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	21017	MD

General Provider Information

NPI Number	:	1033399613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA BORISSOW DPT

Provider Business Mailing Address
First Line	:	11403 ORLEANS WAY
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1020
Country	:	US
Telephone Number	:	240-645-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	11333 WOODGLEN DR
Second Line	:	SUITE 204
City	:	NORTH BETHESDA
State	:	MD
Zip	:	20852-3071
Country	:	US
Telephone Number	:	301-468-2678
Fax Number	:	240-396-5966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	01/31/2012

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