Provider Demographics
NPI:1306174644
Name:BALAJADIA, JOEL ATANGAN (PT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ATANGAN
Last Name:BALAJADIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9688
Mailing Address - Country:US
Mailing Address - Phone:731-394-4390
Mailing Address - Fax:
Practice Address - Street 1:560 MCCLELLAN RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-9688
Practice Address - Country:US
Practice Address - Phone:731-394-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208324006Medicare PIN
IL208325012Medicare PIN