Provider Demographics
NPI:1578996187
Name:BORST, STEPHANIE SUE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUE
Last Name:BORST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUE
Other - Last Name:KOHLWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 N JACKSON BLVD # R
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2521
Mailing Address - Country:US
Mailing Address - Phone:850-235-6360
Mailing Address - Fax:
Practice Address - Street 1:120 N JACKSON BLVD # R
Practice Address - Street 2:SUITE 120
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2521
Practice Address - Country:US
Practice Address - Phone:850-235-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3283225100000X
FL30722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist