Roberta Bornemann, L M T

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA19781 Issued in FL

Practice address

519 Mill Run Drive
New Smyrna, FL 32168

Phone

(386) 428-5914

NPI assigned

Nov 4, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1154608149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 MILL RUN DR",
            "city": "NEW SMYRNA",
            "state": "FL",
            "postal_code": "321681929",
            "telephone_number": "386-428-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 MILL RUN DRIVE",
            "city": "NEW SMYRNA",
            "state": "FL",
            "postal_code": "32168",
            "telephone_number": "386-428-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNEMANN",
        "first_name": "ROBERTA",
        "credential": "L M T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "MA19781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in New Smyrna, FL
• Providers in New Smyrna, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.