Provider Demographics
NPI:1861640948
Name:BALASH, JUDEE LEIGH (PTA)
Entity Type:Individual
Prefix:MS
First Name:JUDEE
Middle Name:LEIGH
Last Name:BALASH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BROAD BLVD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2435
Mailing Address - Country:US
Mailing Address - Phone:330-807-0195
Mailing Address - Fax:
Practice Address - Street 1:1524 BROAD BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2435
Practice Address - Country:US
Practice Address - Phone:330-807-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant