Provider Demographics
NPI:1255436572
Name:BALISTRERI & ASSOCIATES PHYSICAL THERAPY
Entity type:Organization
Organization Name:BALISTRERI & ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALISTRERI-RODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-942-0163
Mailing Address - Street 1:6926 39TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142
Mailing Address - Country:US
Mailing Address - Phone:262-942-0163
Mailing Address - Fax:262-697-1576
Practice Address - Street 1:14999 W BELOIT ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:414-525-7116
Practice Address - Fax:414-525-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty