Provider Demographics
NPI:1326002387
Name:BALANCED BODY GAINESVILLE INC
Entity Type:Organization
Organization Name:BALANCED BODY GAINESVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-3161
Mailing Address - Street 1:4880 W. NEWBERRY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6652
Mailing Address - Country:US
Mailing Address - Phone:352-331-3161
Mailing Address - Fax:352-336-2475
Practice Address - Street 1:4880 W. NEWBERRY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6652
Practice Address - Country:US
Practice Address - Phone:352-331-3161
Practice Address - Fax:352-336-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY901EOtherBLUE CROSS BLUE SHIELD
FLY901EOtherBLUE CROSS BLUE SHIELD