Provider Demographics
NPI:1043413230
Name:BORGESEN, OLE CHRISTIAN (PT)
Entity Type:Individual
Prefix:
First Name:OLE
Middle Name:CHRISTIAN
Last Name:BORGESEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PIPER CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2985
Mailing Address - Country:US
Mailing Address - Phone:415-924-3124
Mailing Address - Fax:
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-898-1311
Practice Address - Fax:415-897-0741
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT270482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27048OtherPHYSICAL THERAPY LICENSE
CAPT27048OtherPHYSICAL THERAPY LICENSE