Provider Demographics
NPI:1336290113
Name:BALBAY, LEVON (PT, MDT)
Entity Type:Individual
Prefix:MR
First Name:LEVON
Middle Name:
Last Name:BALBAY
Suffix:
Gender:M
Credentials:PT, MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24671 MONROE AVENUE, BLDG C, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-200-3620
Mailing Address - Fax:951-200-5811
Practice Address - Street 1:29645 RANCHO CALIFORNIA ROAD SUITE 234
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-506-3001
Practice Address - Fax:951-506-3002
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803503Medicare PIN