Active NPI
Marco Matteo Balassone, PT, DPT
- Physical Therapist
- Agawam, MA
National Provider Identifier
1609244185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 24033
- Practice address
- 464 Main St
Agawam, MA 01001-1826 - Phone
- (860) 794-8719
- NPI assigned
- Sep 14, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4725 | NM | |
| Physical Therapist | 225100000X | 24033 | MA | Primary |
Addresses
Primary practice location
464 Main St
Agawam, MA 01001-1826
Mailing address
1931 Cam Fella St SE
Albuquerque, NM 87123-2393
Phone (860) 794-8719
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609244185 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24033 | MA | MD | Physical Therapist |
| 4725 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1609244185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1931 CAM FELLA ST SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871232393",
"telephone_number": "860-794-8719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 MAIN ST",
"city": "AGAWAM",
"state": "MA",
"postal_code": "010011826",
"telephone_number": "860-794-8719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALASSONE",
"first_name": "MARCO",
"middle_name": "MATTEO",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-14",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "4725",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "24033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1609244185",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Agawam, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.