Basic Information
| Provider Information | |||||||||
| NPI: | 1760791974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALINAS | ||||||||
| FirstName: | EUZAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| OtherLastName: | BALINAS | ||||||||
| OtherFirstName: | EUZAR | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 914 MAIN ST W APT 7 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548061362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085769779 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1319 BEASER AVE | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548063614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156823468 | ||||||||
| FaxNumber: | 7156828872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 07/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11319-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.