Individual provider · NPI-1

Dereck Balbontin

Mechanotherapist · Portland, OR

NPI number1811353063
StatusActive
Last updated in NPPESJan 15, 2016

Details

NPI
1811353063
Entity type
Individual (NPI-1)
Name
Dereck Balbontin
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 4, 2016
Last updated
Jan 15, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172M00000X Mechanotherapist20563ORYes

Practice location

4160 Ne Sandy Blvd
Portland, OR 97212-5336

Phone 503-249-9000

Mailing address

1130 Ne 64th Ave
Portland, OR 97213-4912

Phone 813-470-0322

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