Basic Information
| Provider Information | |||||||||
| NPI: | 1487249843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORKOVEC | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 WISCONSIN AVE | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604022948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083053098 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3190 E MERIDIAN PARK LOOP STE 206A | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073739462 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2021 | ||||||||
| LastUpdateDate: | 03/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0017480 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.