Provider Demographics
NPI:1558390831
Name:BORGERDING, REBECCA SUE (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BORGERDING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 N SCATTERFIELD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2976 N SCATTERFIELD RD STE 150
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1587
Practice Address - Country:US
Practice Address - Phone:317-390-5575
Practice Address - Fax:317-486-2189
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008752A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200822610Medicaid
IN000000483312OtherANTHEM ID
IN363769645OtherTRICARE ID