Provider Demographics
NPI:1043516347
Name:BORGMAN, REBECCA JEAN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1515
Mailing Address - Country:US
Mailing Address - Phone:901-328-2110
Mailing Address - Fax:901-590-3999
Practice Address - Street 1:3180 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1515
Practice Address - Country:US
Practice Address - Phone:901-328-2110
Practice Address - Fax:901-590-3999
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist