MEDICARE: RYAN MICHAEL BALMES DPT

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	PT011265	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629366091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MICHAEL BALMES DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3280 HOWELL MILL RD NW STE 303
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4109
Country	:	US
Telephone Number	:	470-300-6030
Fax Number	:	470-300-6031

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	03/09/2020

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