Provider Demographics
NPI:1770751596
Name:BALSHAW, ANITA (PT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BALSHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VISION PARK BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:281-362-0006
Mailing Address - Fax:281-362-0233
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:281-362-0006
Practice Address - Fax:281-362-0233
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152512111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty