Provider Demographics
NPI:1144822933
Name:BORCHARDT, SOLENNE MORGANE
Entity type:Individual
Prefix:MRS
First Name:SOLENNE
Middle Name:MORGANE
Last Name:BORCHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOLENNE
Other - Middle Name:MORGANE
Other - Last Name:BORCHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 BAY RIDGE AVE STE 410
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3031
Practice Address - Country:US
Practice Address - Phone:443-221-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist