Provider Demographics
NPI:1558189928
Name:BALICANTA, EMILY (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BALICANTA
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 1:1302 THE ALAMEDA APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2647
Mailing Address - Country:US
Mailing Address - Phone:925-997-4094
Mailing Address - Fax:
Practice Address - Street 1:16615 LARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7645
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist