Provider Demographics
NPI:1417482746
Name:BALANCED THERAPY, LLC
Entity Type:Organization
Organization Name:BALANCED THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:203-676-4678
Mailing Address - Street 1:60 CONNOLLY PKWY
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-676-4678
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:SUITE 203A
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-676-4678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty