Basic Information
| Provider Information | |||||||||
| NPI: | 1801886056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORDEN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6264 E. GRANT ROAD | ||||||||
| Address2: | BORDEN PHYSICAL THERAPY, LLC | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208840001 | ||||||||
| FaxNumber: | 5208840199 | ||||||||
| Practice Location | |||||||||
| Address1: | 6264 E. GRANT ROAD | ||||||||
| Address2: | BORDEN PHYSICAL THERAPY, LLC | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208840001 | ||||||||
| FaxNumber: | 5208840199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 10/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 803 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 0803 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | AZ0460450 | 01 | AZ | BCBS | OTHER |