Individual
ALICIA BORAWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
916 TALON DRIVE, OFALLON, IL 62269
(618) 628-8211
(618) 628-0883
Mailing address
916 TALON DRIVE, OFALLON, IL 62269
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070200700034
LICENSE#
MO
01
—
70015764
ILLINOIS LICENSE
IL
01
—
900068033
TAX ID
IL
01
—
MA4343
MISOURI MEDICARE
MO
01
—
P00718773
RAILROAD MEDICARE
IL
Enumeration date
04/13/2007
Last updated
02/19/2013
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