Provider Demographics
NPI:1235361239
Name:BALUYOT, MICHELLANE ALVAREZ (PT ASST)
Entity Type:Individual
Prefix:
First Name:MICHELLANE
Middle Name:ALVAREZ
Last Name:BALUYOT
Suffix:
Gender:F
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2719
Mailing Address - Country:US
Mailing Address - Phone:626-289-4439
Mailing Address - Fax:626-289-0056
Practice Address - Street 1:115 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2719
Practice Address - Country:US
Practice Address - Phone:626-289-4439
Practice Address - Fax:626-289-0056
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT90082251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics