Provider Demographics
NPI:1639486707
Name:BORT, NINA SUZANNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:SUZANNE
Last Name:BORT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 NE 70TH ST
Mailing Address - Street 2:#A210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5818 NE 70TH ST
Practice Address - Street 2:#A210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8100
Practice Address - Country:US
Practice Address - Phone:206-390-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist