Provider Demographics
NPI:1407234917
Name:BALANCED PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BALANCED PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:JAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-485-7468
Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:505-821-3831
Mailing Address - Fax:505-212-0786
Practice Address - Street 1:7849 TRAMWAY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2529
Practice Address - Country:US
Practice Address - Phone:505-821-3831
Practice Address - Fax:505-212-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3845261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83939229Medicaid
NM90075285Medicaid
NM21753750Medicaid
NM55507239Medicaid
NM86559737Medicaid
NM18572723Medicaid
NM84470011Medicaid
NM63127296Medicaid
NM9979590Medicaid