Individual
DERECK BALBONTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4160 NE SANDY BLVD, PORTLAND, OR 97212-5336
(503) 249-9000
Mailing address
1130 NE 64TH AVE, PORTLAND, OR 97213-4912
(813) 470-0322
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
20563
OR
Other
Enumeration date
01/04/2016
Last updated
01/15/2016
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