Provider Demographics
NPI:1851469910
Name:BALCERAK, BRETT JEROME (MPT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:JEROME
Last Name:BALCERAK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1662
Mailing Address - Country:US
Mailing Address - Phone:281-424-7557
Mailing Address - Fax:281-424-7567
Practice Address - Street 1:3818 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1662
Practice Address - Country:US
Practice Address - Phone:281-424-7557
Practice Address - Fax:281-424-7567
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6362783OtherCIGNA
TX2272824OtherFIRST HEALTHCCN
TX7615482OtherAETNA
TX8T1932OtherBLUE CROSS BLUE SHIELD
TX103949000OtherUS DEPT OF LABOR
TX103949000OtherUS DEPT OF LABOR
TX8T1932OtherBLUE CROSS BLUE SHIELD