Provider Demographics
NPI:1164135638
Name:BALANCED LIFE STRONGSVILLE LLC
Entity Type:Organization
Organization Name:BALANCED LIFE STRONGSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:CHOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-554-7370
Mailing Address - Street 1:12241 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3410
Mailing Address - Country:US
Mailing Address - Phone:440-212-7608
Mailing Address - Fax:440-212-7719
Practice Address - Street 1:12241 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3410
Practice Address - Country:US
Practice Address - Phone:440-212-7608
Practice Address - Fax:440-212-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy