Provider Demographics
NPI:1629792890
Name:BALCIUNAS, STEFAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:BALCIUNAS
Suffix:
Gender:M
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 1:2045 CENTRE STONE CT STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4561
Mailing Address - Country:US
Mailing Address - Phone:706-507-3794
Mailing Address - Fax:
Practice Address - Street 1:2045 CENTRE STONE CT STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4561
Practice Address - Country:US
Practice Address - Phone:706-507-3794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP026482T225100000X
TX1367864225100000X
NCCP015272T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist