Provider Demographics
NPI:1407200801
Name:BALANCEOT, INC.
Entity Type:Organization
Organization Name:BALANCEOT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:206-706-0063
Mailing Address - Street 1:2821 NW MARKET ST STE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5815
Mailing Address - Country:US
Mailing Address - Phone:206-706-0063
Mailing Address - Fax:206-508-1265
Practice Address - Street 1:3323 NW 71ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-6146
Practice Address - Country:US
Practice Address - Phone:206-784-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60240376261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy