Provider Demographics
NPI:1972611861
Name:BORELLA, BEVERLY A (PTA)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:A
Last Name:BORELLA
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 1:53585 DOGWOOD DR
Mailing Address - Street 2:PO BOX 1521
Mailing Address - City:NORTH FORK
Mailing Address - State:CA
Mailing Address - Zip Code:93643-9720
Mailing Address - Country:US
Mailing Address - Phone:559-877-4191
Mailing Address - Fax:
Practice Address - Street 1:5533 W HILLSDALE AVE
Practice Address - Street 2:SUITE 'A'
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5138
Practice Address - Country:US
Practice Address - Phone:559-733-2478
Practice Address - Fax:559-733-2470
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1615225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT1615OtherPTA LICENSE NUMBER