Provider Demographics
NPI:1972763860
Name:BORJAS, WALTER (LMT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:BORJAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9582 LAKE CHASE ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1929
Mailing Address - Country:US
Mailing Address - Phone:813-810-9204
Mailing Address - Fax:
Practice Address - Street 1:8019 N HIMES AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2712
Practice Address - Country:US
Practice Address - Phone:813-931-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist