Provider Demographics
NPI:1427833086
Name:BORON, BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BORON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3118
Mailing Address - Country:US
Mailing Address - Phone:415-895-1705
Mailing Address - Fax:
Practice Address - Street 1:9909 MIRA MESA BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1064
Practice Address - Country:US
Practice Address - Phone:858-385-9400
Practice Address - Fax:858-384-1542
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist