Provider Demographics
NPI:1699471581
Name:BORG, DAVIS MADSEN (DPT)
Entity type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:MADSEN
Last Name:BORG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 N PAPAGO AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2059
Mailing Address - Country:US
Mailing Address - Phone:208-912-3531
Mailing Address - Fax:
Practice Address - Street 1:134 E IDAHO AVE
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628-5003
Practice Address - Country:US
Practice Address - Phone:208-337-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist