Provider Demographics
NPI:1124209119
Name:BALANCED REHAB LLC
Entity Type:Organization
Organization Name:BALANCED REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNAOUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-252-2400
Mailing Address - Street 1:160 S BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4408
Mailing Address - Country:US
Mailing Address - Phone:386-252-2400
Mailing Address - Fax:
Practice Address - Street 1:160 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4408
Practice Address - Country:US
Practice Address - Phone:386-252-2400
Practice Address - Fax:386-252-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13031261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH696Medicare PIN