Individual
JUSTIN ANTHONY BORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5429 NORTHLAND DR NE STE A, GRAND RAPIDS, MI 49525-1089
(616) 855-0540
Mailing address
2815 MOORE RD, BAILEY, MI 49303-9604
(719) 452-9952
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502005756
MI
Other
Enumeration date
10/26/2018
Last updated
06/17/2021
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