Provider Demographics
NPI:1013790658
Name:BALCAEN, DIDIER LOUIS (RPT)
Entity Type:Individual
Prefix:MR
First Name:DIDIER
Middle Name:LOUIS
Last Name:BALCAEN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 STONEY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ID
Mailing Address - Zip Code:83847-5038
Mailing Address - Country:US
Mailing Address - Phone:208-267-6460
Mailing Address - Fax:
Practice Address - Street 1:33 ENTERPRISE DR STE 101
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-6266
Practice Address - Country:US
Practice Address - Phone:208-597-7250
Practice Address - Fax:208-550-3752
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist