Provider Demographics
NPI:1346406915
Name:BALANCED BODY PHYSICAL THERAPY, LLP
Entity Type:Organization
Organization Name:BALANCED BODY PHYSICAL THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:POSELEY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-226-0143
Mailing Address - Street 1:1055 W BARAGA AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4068
Mailing Address - Country:US
Mailing Address - Phone:906-226-0143
Mailing Address - Fax:906-226-0152
Practice Address - Street 1:1055 W BARAGA AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4068
Practice Address - Country:US
Practice Address - Phone:906-226-0143
Practice Address - Fax:906-226-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003173261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP47930Medicare PIN