Provider Demographics
NPI:1043648629
Name:REBALANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REBALANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, OCS, MTC
Authorized Official - Phone:646-369-5072
Mailing Address - Street 1:465 CLOTHIER RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2345
Mailing Address - Country:US
Mailing Address - Phone:267-282-1301
Mailing Address - Fax:267-940-1300
Practice Address - Street 1:234 WOODBINE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1930
Practice Address - Country:US
Practice Address - Phone:267-282-1301
Practice Address - Fax:267-940-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty