Provider Demographics
NPI:1548444821
Name:BALASO, ALAN TAMKING (PT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:TAMKING
Last Name:BALASO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 SHORT ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-2717
Mailing Address - Country:US
Mailing Address - Phone:731-723-4473
Mailing Address - Fax:
Practice Address - Street 1:1078 SHORT ANDERSON ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-2717
Practice Address - Country:US
Practice Address - Phone:731-723-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist