Provider Demographics
NPI:1417056318
Name:LIFE IN BALANCE INC
Entity Type:Organization
Organization Name:LIFE IN BALANCE INC
Other - Org Name:LIFE IN BALANCE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:269-687-9594
Mailing Address - Street 1:20 N 2ND ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2259
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:20 N 2ND ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2259
Practice Address - Country:US
Practice Address - Phone:269-687-9594
Practice Address - Fax:269-687-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N14720Medicare PIN