Provider Demographics
NPI:1740313873
Name:BALINNANG, DJOANNA MARIE
Entity type:Individual
Prefix:
First Name:DJOANNA
Middle Name:MARIE
Last Name:BALINNANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 RIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2711
Mailing Address - Country:US
Mailing Address - Phone:815-885-3216
Mailing Address - Fax:
Practice Address - Street 1:5980 W 71ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2711
Practice Address - Country:US
Practice Address - Phone:317-388-0800
Practice Address - Fax:317-388-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008302A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist