Provider Demographics
NPI:1437713203
Name:BALFOUR, ANGEL (LMT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BALFOUR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 ELVIS PRESLEY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7100
Mailing Address - Country:US
Mailing Address - Phone:901-210-0083
Mailing Address - Fax:
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7100
Practice Address - Country:US
Practice Address - Phone:901-210-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist