Provider Demographics
NPI:1497944086
Name:BALUYUT, JENNIFER V (LPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:V
Last Name:BALUYUT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7925
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:
Practice Address - Street 1:2601 E THOMAS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8221
Practice Address - Country:US
Practice Address - Phone:602-424-9880
Practice Address - Fax:602-445-5210
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76832081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine