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General NPI Number Information
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NPI Number | 1245000546
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Entity Type | Individual
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Provider Name | AMAL ALTAYEB EBRAHEEM BALOLA DPT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 4050 W BROWARD BLVD FL 33317
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City | PLANTATION
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State | FL
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Zip | 33317-3767
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Country | US
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Telephone | 888-409-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 NW 92ND TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-1700
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Country | US
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Telephone | 954-470-2253
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT40359
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License Number State | FL
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