Basic Information
| Provider Information | |||||||||
| NPI: | 1750056909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORDEN | ||||||||
| FirstName: | JACEY | ||||||||
| MiddleName: | SHAYE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232387217 | ||||||||
| FaxNumber: | 4239331996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 MARIA LN | ||||||||
| Address2: | |||||||||
| City: | IUKA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388521119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625933111 | ||||||||
| FaxNumber: | 6625933151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT7196 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.