Provider Demographics
NPI:1114524675
Name:BORNEMANN, ALICIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:BORNEMANN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 CYPRESS GARDENS BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2241
Mailing Address - Country:US
Mailing Address - Phone:863-877-0605
Mailing Address - Fax:
Practice Address - Street 1:5535 CYPRESS GARDENS BLVD STE 260
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-2241
Practice Address - Country:US
Practice Address - Phone:863-877-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist