Provider Demographics
NPI:1417141524
Name:BALSER, CRAIG (PT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:BALSER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PROVIDENCE MINE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2947
Mailing Address - Country:US
Mailing Address - Phone:530-265-8100
Mailing Address - Fax:530-265-8112
Practice Address - Street 1:202 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2947
Practice Address - Country:US
Practice Address - Phone:530-265-8100
Practice Address - Fax:530-265-8112
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT187251Medicare PIN