Provider Demographics
NPI:1013044767
Name:BORCHERT, MEGAN BROOKE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:BORCHERT
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442302 ASUI KIBBIE DOME
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83844-2302
Mailing Address - Country:US
Mailing Address - Phone:208-885-0256
Mailing Address - Fax:
Practice Address - Street 1:442302 ASUI KIBBIE DOME
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-2302
Practice Address - Country:US
Practice Address - Phone:208-885-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDATR-2222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer