Provider Demographics
NPI:1114145794
Name:THE CENTER FOR BODIES IN BALANCE, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR BODIES IN BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARCINKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-319-8334
Mailing Address - Street 1:1 GREENLEAF WOODS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5437
Mailing Address - Country:US
Mailing Address - Phone:603-319-8334
Mailing Address - Fax:
Practice Address - Street 1:1 GREENLEAF WOODS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5437
Practice Address - Country:US
Practice Address - Phone:603-319-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-21
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0714225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0948405OtherCIGNA
NH08Y003086NH 02OtherANTHEM
AA49359OtherHARVARD PILGRIM HEALTH CA
4650011OtherAETNA
813530OtherFIRST HEALTH & CCN NETWOR
NH0013114Medicare PIN