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General NPI Number Information
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NPI Number | 1114058641
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Entity Type | Individual
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Provider Name | CONRAD BALMES BACOY
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2401 UNIVERSITY PKWY STE 103
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City | SARASOTA
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State | FL
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Zip | 34243-2894
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Country | US
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Telephone | 941-444-5970
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Fax | 941-444-5971
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Provider Business Mailing Address
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Address Line | 9070 W CHEYENNE AVE STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89129-8935
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Country | US
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Telephone | 702-476-4990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 5501012742
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28218
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License Number State | FL
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