Provider Demographics
NPI:1104021419
Name:BALANCE CENTER OF LAS VEGAS, LLC
Entity Type:Organization
Organization Name:BALANCE CENTER OF LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-341-0606
Mailing Address - Street 1:1750 N BUFFALO DR
Mailing Address - Street 2:UNIT 104-434
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2672
Mailing Address - Country:US
Mailing Address - Phone:702-341-0606
Mailing Address - Fax:702-341-1040
Practice Address - Street 1:321 N BUFFALO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0324
Practice Address - Country:US
Practice Address - Phone:702-341-0606
Practice Address - Fax:702-341-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty