MEDICARE: MR. DAVID NATHANIEL BALDANZA 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	3438	NV
2	225100000X	Physical Therapist	039184-1	NY

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	:	1700244498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID NATHANIEL BALDANZA DPT

Provider Business Mailing Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0329
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0329
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

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

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	10/22/2024

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