Provider Demographics
NPI:1609377951
Name:BORDEN, REBECCA J (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BORDEN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3705 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3705 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4607
Practice Address - Country:US
Practice Address - Phone:806-677-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT66542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer