Provider Demographics
NPI:1437487170
Name:BALANCE HOLISTIC CENTER
Entity Type:Organization
Organization Name:BALANCE HOLISTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-270-7711
Mailing Address - Street 1:1023 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1314
Mailing Address - Country:US
Mailing Address - Phone:401-270-7711
Mailing Address - Fax:401-270-1627
Practice Address - Street 1:1023 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1314
Practice Address - Country:US
Practice Address - Phone:401-270-7711
Practice Address - Fax:401-270-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty