Provider Demographics
NPI:1265033773
Name:BALBONI, ADRIENNE DANETTE
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:DANETTE
Last Name:BALBONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6649
Mailing Address - Country:US
Mailing Address - Phone:850-398-3907
Mailing Address - Fax:
Practice Address - Street 1:12 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1845
Practice Address - Country:US
Practice Address - Phone:954-542-6819
Practice Address - Fax:954-889-1286
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist