Basic Information
| Provider Information | |||||||||
| NPI: | 1336610930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALIKER | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DEMPSEY GLEN LN | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296814873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642752745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 N FANT ST | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121198 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2018 | ||||||||
| LastUpdateDate: | 12/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8026 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.