Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 21265 | CA |
NPI | 1073639613 |
---|---|
Provider Name | Stephen Mitchell Balkam |
First Address | San Diego, CA 92102-3626 |
Second Address | San Diego, CA 92102-3626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |