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ALAN BALAVENDER MS PT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1174605810

Individual Registrant:
 ALAN  BALAVENDER MS PT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
27 DEPOT ST  WATERTOWN, CT 06795-2601 US
Tel: 860-274-4092  Fax: 860-274-4099

Contact information for business:
27 DEPOT ST  WATERTOWN, CT 06795-2601 US
Tel: 860-274-4092  Fax: 860-274-4099

Registration Information:
NPI: 1174605810
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
CT3638

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
ANTHEM BLUE CROSS BLUE SH080003638CT09CT01
ANTHEM BC BS080003638CT12CT01
ANTHEM BC BS080003638CT13CT01
BLUE SHIELD080003638CT14CT01
004201018CT05
BLUE SHIELD080003638CT15CT01
ANTHEM BC BS080003638CT10CT01




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