Provider Demographics
NPI:1083186571
Name:BALAOY, ARCHEBAL ALFECHE
Entity Type:Individual
Prefix:
First Name:ARCHEBAL
Middle Name:ALFECHE
Last Name:BALAOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E ROSEBAY LN APT F
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5915
Mailing Address - Country:US
Mailing Address - Phone:765-744-9600
Mailing Address - Fax:
Practice Address - Street 1:4301 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1190
Practice Address - Country:US
Practice Address - Phone:765-282-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011641A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist