Provider Demographics
NPI:1174019129
Name:BORROMEO, ROBERT (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BORROMEO
Suffix:
Gender:M
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:PO BOX 170040
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0003
Mailing Address - Country:US
Mailing Address - Phone:512-996-0441
Mailing Address - Fax:512-996-0442
Practice Address - Street 1:12617 RIDGELINE BLVD BLDG C105
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1606
Practice Address - Country:US
Practice Address - Phone:512-996-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist