MEDICARE: MR. CRAIG BALSER PT

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	225100000X	Physical Therapist	PT18725	CA

General Provider Information

NPI Number	:	1417141524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG BALSER PT

Provider Business Mailing Address
First Line	:	202 PROVIDENCE MINE RD
Second Line	:	SUITE 206
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2947
Country	:	US
Telephone Number	:	530-265-8100
Fax Number	:	530-265-8112

Provider Business Practice Location Address
First Line	:	202 PROVIDENCE MINE RD
Second Line	:	SUITE 206
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2947
Country	:	US
Telephone Number	:	530-265-8100
Fax Number	:	530-265-8112

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	12/06/2007

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