Organization
ADVANCED BALANCE STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARD DONAYRE MPT (OWNER)
(310) 752-3769
Entity
Organization
Contact information
Practice address
1921 N GAFFEY ST, SUITE I, SAN PEDRO, CA 90731-1264
(310) 833-0300
Mailing address
1921 N GAFFEY ST, SUITE I, SAN PEDRO, CA 90731-1264
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT28434
CA
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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