Provider Demographics
NPI:1942549639
Name:BORDNER, LOIS E (PTA)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:E
Last Name:BORDNER
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 1:117 TARRY HALL RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-9151
Mailing Address - Country:US
Mailing Address - Phone:717-756-2683
Mailing Address - Fax:
Practice Address - Street 1:117 TARRY HALL RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-9151
Practice Address - Country:US
Practice Address - Phone:717-756-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI00061225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant