Provider Demographics
NPI:1700244498
Name:BALDANZA, DAVID NATHANIEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NATHANIEL
Last Name:BALDANZA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:702-839-1114
Mailing Address - Fax:
Practice Address - Street 1:6070 S FORT APACHED RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-839-1114
Practice Address - Fax:702-380-1081
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31138225100000X
NY039184-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVGC779AMedicare PIN
NV1702161Medicaid