Provider Demographics
NPI:1184911091
Name:BALCOMBE, MICHAEL ROWLAND
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROWLAND
Last Name:BALCOMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ROWLAND
Other - Last Name:MARBUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17206 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9103
Mailing Address - Country:US
Mailing Address - Phone:425-743-3486
Mailing Address - Fax:
Practice Address - Street 1:17206 NORTH RD
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9103
Practice Address - Country:US
Practice Address - Phone:425-743-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPI-60048994225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant