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General NPI Number Information
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NPI Number | 1972902799
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Entity Type | Individual
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Provider Name | JACKIE BALZER DPT
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 1260 E MAIN ST
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City | MERIDEN
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State | CT
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Zip | 06450-4806
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Country | US
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Telephone | 203-630-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 91 ELM ST APT 405C
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City | MANCHESTER
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State | CT
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Zip | 06040-8625
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Country | US
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Telephone | 520-360-2500
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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 | 010262
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License Number State | CT
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