Provider Demographics
NPI:1114198462
Name:MERCEDES ENTERPRISE
Entity Type:Organization
Organization Name:MERCEDES ENTERPRISE
Other - Org Name:JOE BORLAND, R.P.T.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:BORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO, RPT
Authorized Official - Phone:626-445-1978
Mailing Address - Street 1:660 W DUARTE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7618
Mailing Address - Country:US
Mailing Address - Phone:626-445-1978
Mailing Address - Fax:626-574-1999
Practice Address - Street 1:660 W DUARTE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7618
Practice Address - Country:US
Practice Address - Phone:626-445-1978
Practice Address - Fax:626-574-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5821261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT5821Medicare PIN