Provider Demographics
NPI:1164967725
Name:REBALANCE CENTER, LLC
Entity Type:Organization
Organization Name:REBALANCE CENTER, LLC
Other - Org Name:RH WELLNESS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, LPTA
Authorized Official - Phone:231-218-1266
Mailing Address - Street 1:812 S GARFIELD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-218-1266
Mailing Address - Fax:231-421-9193
Practice Address - Street 1:812 S GARFIELD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-218-1266
Practice Address - Fax:231-421-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548544646OtherNPI TYPE 1