Provider Demographics
NPI:1962622282
Name:BORDELON, PATRICIA L (PT, DPT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BORDELON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6612
Mailing Address - Country:US
Mailing Address - Phone:210-386-1007
Mailing Address - Fax:210-314-7376
Practice Address - Street 1:526 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6612
Practice Address - Country:US
Practice Address - Phone:210-386-1007
Practice Address - Fax:210-314-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist