Provider Demographics
NPI:1326229667
Name:BORMAN, NICOLE PATRICE (PT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:PATRICE
Last Name:BORMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7137
Mailing Address - Country:US
Mailing Address - Phone:972-978-4117
Mailing Address - Fax:214-706-2310
Practice Address - Street 1:6522 UNION ST
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7137
Practice Address - Country:US
Practice Address - Phone:972-978-4117
Practice Address - Fax:214-706-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist