Provider Demographics
NPI:1164644605
Name:BALANCED THERAPY LLC
Entity Type:Organization
Organization Name:BALANCED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUOHY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:970-708-4042
Mailing Address - Street 1:PO BOX 2228
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-2228
Mailing Address - Country:US
Mailing Address - Phone:970-708-4042
Mailing Address - Fax:
Practice Address - Street 1:622 MOUNTAIN VILLAGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:81435-9505
Practice Address - Country:US
Practice Address - Phone:970-728-8948
Practice Address - Fax:970-728-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy