Provider Demographics
NPI:1316592678
Name:BALANCE AQUATIC AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BALANCE AQUATIC AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-870-0044
Mailing Address - Street 1:6898 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6158
Mailing Address - Country:US
Mailing Address - Phone:254-870-0044
Mailing Address - Fax:254-870-6001
Practice Address - Street 1:6898 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6158
Practice Address - Country:US
Practice Address - Phone:254-870-0044
Practice Address - Fax:254-870-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty