Provider Demographics
NPI:1558735233
Name:BALYER, ANDREA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BALYER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HIGHLAND AVE
Mailing Address - Street 2:MAIL STOP 2424
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:MAIL STOP 2424
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-2424
Practice Address - Country:US
Practice Address - Phone:608-263-8060
Practice Address - Fax:608-262-7679
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13246-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI225100000XMedicaid
WI225100000XMedicare UPIN
WI225100000XMedicaid
WI225100000XMedicare Oscar/Certification