Provider Demographics
NPI:1902961881
Name:BALMOS, TRICIA (MS, PT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:BALMOS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13623 WAVERLY CREST CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6830
Mailing Address - Country:US
Mailing Address - Phone:281-213-4064
Mailing Address - Fax:
Practice Address - Street 1:14815 CYPRESS NORTH HOUSTON RD STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6182
Practice Address - Country:US
Practice Address - Phone:281-477-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2881OtherBLUE CROSS BLUE SHIELD