Provider Demographics
NPI:1407069156
Name:BALMER, MICHAEL (LMP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BALMER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 MERIDIAN E. #C-102
Mailing Address - Street 2:PMB 218
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-576-8278
Mailing Address - Fax:
Practice Address - Street 1:5310 138TH ST. E.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446
Practice Address - Country:US
Practice Address - Phone:253-576-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist