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ALAN BALAVENDER MS PT
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1174605810
Individual Registrant: ALAN BALAVENDER MS PT
Gender: M
Not Sole Proprietor
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
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
Tel: 860-274-4092 Fax: 860-274-4099
Registration Information:
NPI: 1174605810
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | CT | 3638 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SH | 080003638CT09 | CT | 01 |
| ANTHEM BC BS | 080003638CT12 | CT | 01 |
| ANTHEM BC BS | 080003638CT13 | CT | 01 |
| BLUE SHIELD | 080003638CT14 | CT | 01 |
| 004201018 | CT | 05 | |
| BLUE SHIELD | 080003638CT15 | CT | 01 |
| ANTHEM BC BS | 080003638CT10 | CT | 01 |
