Provider Demographics
NPI:1275040206
Name:LIFE BALANCE FITNESS, LLC
Entity Type:Organization
Organization Name:LIFE BALANCE FITNESS, LLC
Other - Org Name:LOVING THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-888-2182
Mailing Address - Street 1:203 FOREST PARK CIR STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4916
Mailing Address - Country:US
Mailing Address - Phone:850-888-2182
Mailing Address - Fax:
Practice Address - Street 1:203 FOREST PARK CIR STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-888-2182
Practice Address - Fax:850-888-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14988261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)