Provider Demographics
NPI:1174167928
Name:BORNEMISS, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BORNEMISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1750
Mailing Address - Country:US
Mailing Address - Phone:330-534-8500
Mailing Address - Fax:330-534-3926
Practice Address - Street 1:168 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1416
Practice Address - Country:US
Practice Address - Phone:330-637-0080
Practice Address - Fax:330-637-0010
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty