Provider Demographics
NPI:1679506786
Name:BALBARIN, MICHAEL ZARSADIAZ (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ZARSADIAZ
Last Name:BALBARIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 S CALICO RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9587
Mailing Address - Country:US
Mailing Address - Phone:480-636-7880
Mailing Address - Fax:480-636-7880
Practice Address - Street 1:4369 E VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8003
Practice Address - Country:US
Practice Address - Phone:480-329-7447
Practice Address - Fax:480-636-7880
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107769Medicare ID - Type Unspecified