Jacob David Balca, ATS STUDENT

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Kent, OH

NPI 1467908145 · NPPES record last updated Aug 31, 2016

Key facts

NPI
1467908145
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
4088 Chapman Dr
Kent, OH 44240-6876
Phone
(330) 472-6525
NPI assigned
Aug 31, 2016
Sex
Male
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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

4088 Chapman Dr
Kent, OH 44240-6876

Mailing address

4088 Chapman Dr
Kent, OH 44240-6876
Phone (330) 472-6525

Other providers in Kent, OH

All providers in Kent, OH · Student in an Organized Health Care Education/Training Program in Ohio

Sources for this page

Verify at the official NPI Registry.