Provider Demographics
NPI:1437438801
Name:ADVENTURES IN BALANCE, LLC
Entity Type:Organization
Organization Name:ADVENTURES IN BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-642-9444
Mailing Address - Street 1:45 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2964
Mailing Address - Country:US
Mailing Address - Phone:770-642-9444
Mailing Address - Fax:855-223-5462
Practice Address - Street 1:45 W CROSSVILLE RD
Practice Address - Street 2:SUITE 514
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:770-642-9444
Practice Address - Fax:855-223-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007668261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA282006299DMedicaid
3076Medicare PIN