Provider Demographics
NPI:1184650939
Name:BALES, DAVID L (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:BALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:DAVE
Other - Middle Name:
Other - Last Name:BALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304-1083
Mailing Address - Country:US
Mailing Address - Phone:231-745-2155
Mailing Address - Fax:231-745-4165
Practice Address - Street 1:887 7TH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304-5104
Practice Address - Country:US
Practice Address - Phone:231-745-2155
Practice Address - Fax:231-745-4165
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist