Provider Demographics
NPI:1750712329
Name:BORCHARDT, DAVID (ATC, MED)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BORCHARDT
Suffix:
Gender:M
Credentials:ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BROAD ST
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-3302
Mailing Address - Country:US
Mailing Address - Phone:215-204-7444
Mailing Address - Fax:215-204-2133
Practice Address - Street 1:1800 N BROAD ST
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3302
Practice Address - Country:US
Practice Address - Phone:215-204-7444
Practice Address - Fax:215-204-2133
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer