Provider Demographics
NPI:1982140026
Name:BOREK, TERRANCE (LMP)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:BOREK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WILKES ST
Mailing Address - Street 2:# 104
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2125
Mailing Address - Country:US
Mailing Address - Phone:253-248-7888
Mailing Address - Fax:
Practice Address - Street 1:215 WILKES ST
Practice Address - Street 2:# 104
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-2125
Practice Address - Country:US
Practice Address - Phone:253-248-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist