MEDICARE: MS. GAIL C BALAS LMT

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	225700000X	Massage Therapist	005141-1	NY

General Provider Information

NPI Number	:	1902031172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL C BALAS LMT

Provider Business Mailing Address
First Line	:	767 LEXINGTON AVE
Second Line	:	SUITE 604
City	:	NEW YORK
State	:	NY
Zip	:	10065-8553
Country	:	US
Telephone Number	:	212-755-1607
Fax Number	:

Provider Business Practice Location Address
First Line	:	767 LEXINGTON AVE
Second Line	:	SUITE 604
City	:	NEW YORK
State	:	NY
Zip	:	10065-8553
Country	:	US
Telephone Number	:	212-755-1607
Fax Number	:

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

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/18/2009

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