Provider Demographics
NPI:1467587782
Name:BORRELLI, KEVIN A (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:BORRELLI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:A
Other - Last Name:BORRELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-294-9140
Mailing Address - Fax:828-294-9159
Practice Address - Street 1:232 SHARON AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4326
Practice Address - Country:US
Practice Address - Phone:828-758-7565
Practice Address - Fax:828-758-7595
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist