1538362579 NPI number — SHARON PUTNEY BORGGAARD PHYSICAL THERAPIST

Table of content: SHARON PUTNEY BORGGAARD PHYSICAL THERAPIST (NPI 1538362579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538362579 NPI number — SHARON PUTNEY BORGGAARD PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORGGAARD
Provider First Name:
SHARON
Provider Middle Name:
PUTNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUTNEY
Provider Other First Name:
SHARON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538362579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
25 MAZIES LA
Provider Business Mailing Address City Name:
HOLDERNESS
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-968-7986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 MAZIES LANE
Provider Second Line Business Practice Location Address:
OFF BENNETT COVE LANE
Provider Business Practice Location Address City Name:
HOLDERNESS
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03245-0039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-968-7986
Provider Business Practice Location Address Fax Number:
603-968-7986
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1774 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 1586 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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