Provider Demographics
NPI:1053468223
Name:BORCHARDT, BRIAN ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALLEN
Last Name:BORCHARDT
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 1:7119 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-4714
Mailing Address - Country:US
Mailing Address - Phone:701-281-1864
Mailing Address - Fax:701-281-1924
Practice Address - Street 1:7119 MAPLE LN
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-4714
Practice Address - Country:US
Practice Address - Phone:701-281-1864
Practice Address - Fax:701-281-1924
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11212251P0200X
MN67752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23319OtherND BLUE CROSS BLUE SHIELD
821945OtherAMERICAS PPO
64-05520OtherAETNA
64-05520OtherMEDICA, UNITED HEALTHCARE
ND51319Medicaid
HP50726OtherHEALTH PARTNERS
9075049OtherPRIVATE HEALTHCARE SYSTEM