Provider Demographics
NPI:1346524501
Name:BORDEN, BOBBIE J (PTA)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:BORDEN
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 1:687 LEE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4257
Mailing Address - Country:US
Mailing Address - Phone:585-458-7910
Mailing Address - Fax:585-458-7507
Practice Address - Street 1:687 LEE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-458-7910
Practice Address - Fax:585-458-7507
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005200-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant