Provider Demographics
NPI:1154827186
Name:BORDER, REBECCA RUTH (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:BORDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 ZUNI ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1377
Mailing Address - Country:US
Mailing Address - Phone:303-667-1832
Mailing Address - Fax:
Practice Address - Street 1:7610 W 5TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1404
Practice Address - Country:US
Practice Address - Phone:303-667-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0019444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty