Provider Demographics
NPI:1871717231
Name:BORAWSKI, ALICIA (MPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BORAWSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:R
Other - Last Name:COURTOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:916 TALON DRIVE
Mailing Address - Street 2:
Mailing Address - City:OFALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-628-8211
Mailing Address - Fax:618-628-0883
Practice Address - Street 1:916 TALON DRIVE
Practice Address - Street 2:
Practice Address - City:OFALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-628-8211
Practice Address - Fax:618-628-0883
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900068033OtherTAX ID
MOMA4343OtherMISOURI MEDICARE
IL70015764OtherILLINOIS LICENSE
ILP00718773OtherRAILROAD MEDICARE
MO070200700034OtherLICENSE#
IL900068033OtherTAX ID