Provider Demographics
NPI:1336661750
Name:BALANCE AND VESTIBULAR CENTER OF KING OF PRUSSIA LLC
Entity Type:Organization
Organization Name:BALANCE AND VESTIBULAR CENTER OF KING OF PRUSSIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LING
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:610-265-5305
Mailing Address - Street 1:1004 W 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1217
Mailing Address - Country:US
Mailing Address - Phone:610-265-5305
Mailing Address - Fax:610-265-5306
Practice Address - Street 1:1004 W 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1217
Practice Address - Country:US
Practice Address - Phone:610-265-5305
Practice Address - Fax:610-265-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015319225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty