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NPI Code Detail

MEDICARE: MENALYN BALANCIO JABONETE PT/L

MEDICARE: MENALYN BALANCIO JABONETE PT/L
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
1225100000XPhysical Therapist2305206337VA
2225100000XPhysical Therapist36897CA
3225100000XPhysical Therapist3340NM

General Provider Information

NPI Number : 1568661205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MENALYN BALANCIO JABONETE PT/L
Provider Business Mailing Address
First Line : 2330 NEVADA AVE APT 506
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1417
Country : US
Telephone Number : 505-639-3338
Fax Number :
Provider Business Practice Location Address
First Line : 1005 LUJAN HILL RD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007-6304
Country : US
Telephone Number : 505-523-4573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2007
Last Update Date : 11/07/2019

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