Provider Demographics
NPI:1306166293
Name:BORIO, MA. TERESITA AQUINO (PTA)
Entity type:Individual
Prefix:
First Name:MA. TERESITA
Middle Name:AQUINO
Last Name:BORIO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 VINE ST
Mailing Address - Street 2:APT. C
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1517
Mailing Address - Country:US
Mailing Address - Phone:213-458-0426
Mailing Address - Fax:818-507-0224
Practice Address - Street 1:431 VINE ST
Practice Address - Street 2:APT. C
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1517
Practice Address - Country:US
Practice Address - Phone:213-458-0426
Practice Address - Fax:818-507-0224
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant