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General NPI Number Information
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NPI Number | 1235361239
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Entity Type | Individual
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Provider Name | MICHELLANE ALVAREZ BALUYOT PT ASST
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 115 BRIDGE ST
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2719
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Country | US
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Telephone | 626-289-4439
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Fax | 626-289-0056
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Provider Business Mailing Address
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Address Line | 115 BRIDGE ST
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2719
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Country | US
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Telephone | 626-289-4439
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Fax | 626-289-0056
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | AT9008
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License Number State | CA
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