Provider Demographics
NPI:1598925927
Name:BALLE, STEVEN GERALD
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GERALD
Last Name:BALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 S HARBOUR SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-1229
Mailing Address - Country:US
Mailing Address - Phone:208-468-9674
Mailing Address - Fax:
Practice Address - Street 1:714 N BUTTE AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2725
Practice Address - Country:US
Practice Address - Phone:208-365-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist