Provider Demographics
NPI:1366682510
Name:BALANCED LIFE THERAPY CENTER, INC
Entity Type:Organization
Organization Name:BALANCED LIFE THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-374-9052
Mailing Address - Street 1:1913 W SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5813
Mailing Address - Country:US
Mailing Address - Phone:813-374-9052
Mailing Address - Fax:813-374-9053
Practice Address - Street 1:1913 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5813
Practice Address - Country:US
Practice Address - Phone:813-374-9052
Practice Address - Fax:813-374-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty