Provider Demographics
NPI:1437158029
Name:BODY IN BALANCE, INC.
Entity Type:Organization
Organization Name:BODY IN BALANCE, INC.
Other - Org Name:BODY IN BALANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAROLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-758-2111
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0039
Mailing Address - Country:US
Mailing Address - Phone:941-758-2111
Mailing Address - Fax:
Practice Address - Street 1:5108 BEACON RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8764
Practice Address - Country:US
Practice Address - Phone:941-758-2111
Practice Address - Fax:941-758-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902KOtherBCBS FLORIDA
FLK4747Medicare ID - Type Unspecified