Provider Demographics
NPI:1255853404
Name:BALAZS, LASZLO (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:LASZLO
Middle Name:
Last Name:BALAZS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1106
Mailing Address - Country:US
Mailing Address - Phone:703-765-7275
Mailing Address - Fax:
Practice Address - Street 1:1300 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1106
Practice Address - Country:US
Practice Address - Phone:703-765-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist