Provider Demographics
NPI:1306041488
Name:BORREGO, ANGELICA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:
Last Name:BORREGO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N 84TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-5788
Mailing Address - Country:US
Mailing Address - Phone:956-207-6487
Mailing Address - Fax:956-381-0344
Practice Address - Street 1:3130 N 23RD ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6139
Practice Address - Country:US
Practice Address - Phone:956-630-2850
Practice Address - Fax:956-687-5638
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2010112225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant