Active NPI
Jackie Balzer, DPT
- Physical Therapist
- Meriden, CT
National Provider Identifier
1972902799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 010262
- Practice address
- 1260 E Main St
Meriden, CT 06450-4806 - Phone
- (203) 630-3939
- NPI assigned
- Aug 18, 2014
- Last updated
- Aug 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 010262 | CT | Primary |
Addresses
Primary practice location
1260 E Main St
Meriden, CT 06450-4806
Mailing address
91 Elm St
Apt 405C
Manchester, CT 06040-8625
Phone (520) 360-2500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D100085342 | Other | CT | MEDICARE PTAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010262 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408320000000",
"number": "1972902799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 ELM ST",
"address_2": "APT 405C",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060408625",
"telephone_number": "520-360-2500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1260 E MAIN ST",
"city": "MERIDEN",
"state": "CT",
"postal_code": "064504806",
"telephone_number": "203-630-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALZER",
"first_name": "JACKIE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-18",
"last_updated": "2014-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "010262",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "D100085342",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meriden, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.