Provider Demographics
NPI:1366925885
Name:BALBOA, SCARLETT J (PT, DPT)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:J
Last Name:BALBOA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1644
Mailing Address - Country:US
Mailing Address - Phone:754-423-6686
Mailing Address - Fax:
Practice Address - Street 1:2229 N COMMERCE PKWY STE 250
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3283
Practice Address - Country:US
Practice Address - Phone:954-659-8986
Practice Address - Fax:954-659-8987
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist