Provider Demographics
NPI:1982939963
Name:BALAZS, GERALYN MARIE (NCTMB, LMT)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:MARIE
Last Name:BALAZS
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5536
Mailing Address - Country:US
Mailing Address - Phone:847-637-0002
Mailing Address - Fax:
Practice Address - Street 1:1416 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5536
Practice Address - Country:US
Practice Address - Phone:847-637-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.008647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist