Provider Demographics
NPI:1710375779
Name:BALORIO, MARIA TERESITA NANTES (PT)
Entity Type:Individual
Prefix:
First Name:MARIA TERESITA
Middle Name:NANTES
Last Name:BALORIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 N OLCOTT AVE
Mailing Address - Street 2:APT GE
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4630
Mailing Address - Country:US
Mailing Address - Phone:773-683-8838
Mailing Address - Fax:
Practice Address - Street 1:4720 N OLCOTT AVE
Practice Address - Street 2:APT GE
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4630
Practice Address - Country:US
Practice Address - Phone:773-683-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist