Provider Demographics
NPI:1790219723
Name:BALZER, DAVID G (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BALZER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19420 N 59TH AVE
Mailing Address - Street 2:SUITE E-500
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6817
Mailing Address - Country:US
Mailing Address - Phone:623-208-7575
Mailing Address - Fax:866-281-9664
Practice Address - Street 1:19420 N 59TH AVE
Practice Address - Street 2:SUITE E-500
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6817
Practice Address - Country:US
Practice Address - Phone:623-208-7575
Practice Address - Fax:866-281-9664
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist