Provider Demographics
NPI:1326413659
Name:BALONICK, CHYNA M (PT)
Entity Type:Individual
Prefix:
First Name:CHYNA
Middle Name:M
Last Name:BALONICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16271 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4102
Mailing Address - Country:US
Mailing Address - Phone:714-375-1755
Mailing Address - Fax:714-375-1757
Practice Address - Street 1:16271 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4102
Practice Address - Country:US
Practice Address - Phone:714-375-1755
Practice Address - Fax:714-375-1757
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist