Provider Demographics
NPI:1043657828
Name:BODYBALANCE PT TWIN FALLS LLC
Entity Type:Organization
Organization Name:BODYBALANCE PT TWIN FALLS LLC
Other - Org Name:BODYBALANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-9011
Mailing Address - Street 1:1896 CANDLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8302
Mailing Address - Country:US
Mailing Address - Phone:208-734-6172
Mailing Address - Fax:
Practice Address - Street 1:657 BLUE LAKES BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4036
Practice Address - Country:US
Practice Address - Phone:208-934-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BBPT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation