Provider Demographics
NPI:1285825067
Name:ELECCION, EARL BALBUENA (PT)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:BALBUENA
Last Name:ELECCION
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:430 CHAPARRALL CREEK DR
Mailing Address - Street 2:APT 2602
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3959
Mailing Address - Country:US
Mailing Address - Phone:417-437-4389
Mailing Address - Fax:
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:SUITE D & E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2501
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006015792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist