Provider Demographics
NPI:1588611388
Name:BALZIS, BETHANY SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:SUE
Last Name:BALZIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 PLACER CREEK CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2312
Mailing Address - Country:US
Mailing Address - Phone:505-856-0850
Mailing Address - Fax:
Practice Address - Street 1:4824 MCMAHON BLVD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5412
Practice Address - Country:US
Practice Address - Phone:505-897-3575
Practice Address - Fax:505-897-3726
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist