Provider Demographics
NPI:1497409023
Name:THE BALANCED MOMTALITY WOMEN'S HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:THE BALANCED MOMTALITY WOMEN'S HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-803-2142
Mailing Address - Street 1:1745 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2146
Mailing Address - Country:US
Mailing Address - Phone:505-803-2142
Mailing Address - Fax:
Practice Address - Street 1:190 CENTRAL PARK SQ STE 214A
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4004
Practice Address - Country:US
Practice Address - Phone:505-803-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty