Provider Demographics
NPI:1992185268
Name:BALETE, GLORIA (PT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BALETE
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 1:10404 47TH AVE
Mailing Address - Street 2:APT 3I
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3821
Mailing Address - Country:US
Mailing Address - Phone:646-203-5846
Mailing Address - Fax:
Practice Address - Street 1:10404 47TH AVE
Practice Address - Street 2:APT 3I
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3821
Practice Address - Country:US
Practice Address - Phone:646-203-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist