Individual
DR. JACKIE BALZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1260 E MAIN ST, MERIDEN, CT 06450-4806
(203) 630-3939
Mailing address
91 ELM ST, APT 405C, MANCHESTER, CT 06040-8625
(520) 360-2500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
010262
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D100085342
MEDICARE PTAN
CT
Enumeration date
08/18/2014
Last updated
08/18/2014
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