MEDICARE: PETER A BORNROPP CRC

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	225C00000X	Rehabilitation Counselor	4985	MT

General Provider Information

NPI Number	:	1760670905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A BORNROPP CRC

Provider Business Mailing Address
First Line	:	800 KENSINGTON AVE STE 203
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5670
Country	:	US
Telephone Number	:	406-542-2234
Fax Number	:	877-475-2401

Provider Business Practice Location Address
First Line	:	800 KENSINGTON AVE STE 203
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5670
Country	:	US
Telephone Number	:	406-542-2234
Fax Number	:	877-475-2401

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/12/2007

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