Provider Demographics
NPI:1225210396
Name:BODY IN BALANCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BODY IN BALANCE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEAUCHESNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-324-3745
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-0015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 DAIGLE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-4173
Practice Address - Country:US
Practice Address - Phone:207-324-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME041334OtherANTHEM BC/BS
ME041334OtherANTHEM BC/BS