Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT 29038 | FL |
NPI | 1336523786 |
---|---|
Provider Name | Staci Balkan |
First Address | Jacksonville, FL 32216-2521 |
Second Address | Jacksonville, FL 32216-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2015 |
Last Update Date | 15/07/2015 |