Provider Demographics
NPI:1841683547
Name:BORJA, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BORJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44656 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1322
Mailing Address - Country:US
Mailing Address - Phone:586-884-4565
Mailing Address - Fax:888-996-2534
Practice Address - Street 1:44656 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1322
Practice Address - Country:US
Practice Address - Phone:586-884-4565
Practice Address - Fax:888-996-2534
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist