Provider Demographics
NPI:1396796876
Name:BALOGH, JASON P (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:BALOGH
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 1:4817 LEAH DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-7525
Mailing Address - Country:US
Mailing Address - Phone:814-774-1080
Mailing Address - Fax:
Practice Address - Street 1:3010 W LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3849
Practice Address - Country:US
Practice Address - Phone:814-833-2022
Practice Address - Fax:814-838-1223
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008837225100000X
PAPT013903L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist