MEDICARE: MR. BRIAN JOSEPH BORDEN P.T.

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	PT22603	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT22603	OTHER	FL	PT LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427119437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JOSEPH BORDEN P.T.

Provider Business Mailing Address
First Line	:	105 SOUTHPARK BLVD STE B201
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5159
Country	:	US
Telephone Number	:	904-824-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S STE 160
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3235
Country	:	US
Telephone Number	:	904-339-8406
Fax Number	:	904-339-8407

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/20/2023

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