Provider Demographics
NPI:1700368727
Name:BORIGO, MEGAN JAYNE (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JAYNE
Last Name:BORIGO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 FM 1488 RD APT 2431
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4932
Mailing Address - Country:US
Mailing Address - Phone:717-676-5818
Mailing Address - Fax:
Practice Address - Street 1:19333 US-59
Practice Address - Street 2:SUITE 230
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-548-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2137439225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant