Provider Demographics
NPI:1871879155
Name:BORRON, TODD (LMT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:BORRON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NE MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1775
Mailing Address - Country:US
Mailing Address - Phone:573-692-0000
Mailing Address - Fax:
Practice Address - Street 1:203 NE MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1775
Practice Address - Country:US
Practice Address - Phone:573-692-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003006161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist