Provider Demographics
NPI:1083105761
Name:BALCITA, BRUCE JR (DPT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BALCITA
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 UNION AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5574
Mailing Address - Country:US
Mailing Address - Phone:541-974-8572
Mailing Address - Fax:
Practice Address - Street 1:337 UNION AVE STE D
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5574
Practice Address - Country:US
Practice Address - Phone:541-974-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist