Healthcare Provider Details

I. General information

NPI: 1831193309
Provider Name (Legal Business Name): DAVID BRANDON BALENGER D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BILL ROBISON PKWY STE C CENTRAL PARK
ANNISTON AL
36206-2610
US

IV. Provider business mailing address

100 BILL ROBISON PKWY STE C
ANNISTON AL
36206-2610
US

V. Phone/Fax

Practice location:
  • Phone: 256-820-8555
  • Fax: 256-820-8554
Mailing address:
  • Phone: 256-820-8555
  • Fax: 256-820-8554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4175
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: