Provider Demographics
NPI:1801886056
Name:BORDEN, TIMOTHY MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:BORDEN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:6264 E. GRANT ROAD
Mailing Address - Street 2:BORDEN PHYSICAL THERAPY, LLC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5882
Mailing Address - Country:US
Mailing Address - Phone:520-884-0001
Mailing Address - Fax:520-884-0199
Practice Address - Street 1:6264 E. GRANT ROAD
Practice Address - Street 2:BORDEN PHYSICAL THERAPY, LLC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5882
Practice Address - Country:US
Practice Address - Phone:520-884-0001
Practice Address - Fax:520-884-0199
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2017-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ803225100000X
AZ08032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0460450OtherBCBS
AZAZ0460450OtherBCBS