Individual
MR. BALEMBA KUBUANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1941 SAVAGE RD, SUITE 400C, CHARLESTON, SC 29407-4704
(843) 571-2700
Mailing address
11419 ERWIN RIDGE AVE, CHARLOTTE, NC 28213-4866
(704) 688-0121
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1242
NC
225200000X
Physical Therapy Assistant
Primary
698
SC
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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