Provider Demographics
NPI:1093115750
Name:BALANCED PHYSICAL THERAPY AND FITNESS, PC
Entity Type:Organization
Organization Name:BALANCED PHYSICAL THERAPY AND FITNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:WANDA
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-229-7980
Mailing Address - Street 1:327 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5034
Mailing Address - Country:US
Mailing Address - Phone:909-809-8322
Mailing Address - Fax:
Practice Address - Street 1:11326 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3817
Practice Address - Country:US
Practice Address - Phone:909-229-7980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34098261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy