Provider Demographics
NPI:1467126201
Name:BALANCE FOR LIFE: MIND, BODY & SOUL HEALING
Entity Type:Organization
Organization Name:BALANCE FOR LIFE: MIND, BODY & SOUL HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-736-9999
Mailing Address - Street 1:248 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:SEIDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2570
Mailing Address - Country:US
Mailing Address - Phone:631-736-9999
Mailing Address - Fax:
Practice Address - Street 1:248 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 16B
Practice Address - City:SEIDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2570
Practice Address - Country:US
Practice Address - Phone:631-736-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLOUD 9 MASSAGE THERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty