Provider Demographics
NPI:1346486370
Name:PERFECT BALANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PERFECT BALANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-366-4069
Mailing Address - Street 1:876 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6529
Mailing Address - Country:US
Mailing Address - Phone:612-366-4069
Mailing Address - Fax:
Practice Address - Street 1:876 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6529
Practice Address - Country:US
Practice Address - Phone:612-366-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy