MEDICARE: EVANGELICA BALANZAR MURPHY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant		CA

General Provider Information

NPI Number	:	1124717483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELICA BALANZAR MURPHY PTA

Provider Business Mailing Address
First Line	:	4560 SE INTERNATIONAL WAY STE 100
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-206-5223
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 W CECIL CT
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-9755
Country	:	US
Telephone Number	:	559-908-8041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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