Provider Demographics
NPI:1235122367
Name:BORGESON, SANDY KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:KAY
Last Name:BORGESON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5459
Mailing Address - Country:US
Mailing Address - Phone:816-454-5818
Mailing Address - Fax:
Practice Address - Street 1:5536 NE ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2301
Practice Address - Country:US
Practice Address - Phone:816-454-5818
Practice Address - Fax:816-454-5818
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117156225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant