Provider Demographics
NPI:1518533025
Name:BORDONARO, PHILLIP A
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:BORDONARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PINGREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-5372
Mailing Address - Country:US
Mailing Address - Phone:603-537-9767
Mailing Address - Fax:
Practice Address - Street 1:27 PINGREE HILL RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-5372
Practice Address - Country:US
Practice Address - Phone:603-537-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH633M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist