Provider Demographics
NPI:1871074542
Name:BORGER, MARY NELL RITTMANN (PTA)
Entity type:Individual
Prefix:
First Name:MARY NELL
Middle Name:RITTMANN
Last Name:BORGER
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 1:1517 TRAFALGAR RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1831
Mailing Address - Country:US
Mailing Address - Phone:817-732-5199
Mailing Address - Fax:
Practice Address - Street 1:4201 STONEGATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9503
Practice Address - Country:US
Practice Address - Phone:817-924-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2066200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant