Jessie Balicki
Individual provider Active NPI Physical Therapist · Bountiful, UT
NPI 1093215568 · NPPES record last updated Feb 20, 2018
Key facts
- NPI
- 1093215568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9251212-2401 (UT)
- Practice address
- 523 N Main St
Bountiful, UT 84010-6036 - Phone
- (801) 951-2273
- NPI assigned
- Feb 20, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9251212-2401 | UT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9251212-2401 | UT | Yes |
Addresses
Primary practice location
523 N Main St
Bountiful, UT 84010-6036
Mailing address
206 N 2100 W
Salt Lake City, UT 84116-4740
Phone (801) 456-8409
Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.