Healthcare Provider Details

I. General information

NPI: 1902339351
Provider Name (Legal Business Name): ERIC BALAS PTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-5113
US

IV. Provider business mailing address

PO BOX 764
NORTH CONWAY NH
03860-0764
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-6400
  • Fax:
Mailing address:
  • Phone: 603-356-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: