Provider Demographics
NPI:1306694328
Name:BALES, ELVA JANETTE
Entity type:Individual
Prefix:
First Name:ELVA
Middle Name:JANETTE
Last Name:BALES
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 1:1884 LITTLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WALLSBURG
Mailing Address - State:UT
Mailing Address - Zip Code:84082-9782
Mailing Address - Country:US
Mailing Address - Phone:707-628-9056
Mailing Address - Fax:
Practice Address - Street 1:544 E 1200 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4497
Practice Address - Country:US
Practice Address - Phone:435-654-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13903889-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist