Provider Demographics
NPI:1497518831
Name:BODY IN BALANCE THERAPY, LLC.
Entity Type:Organization
Organization Name:BODY IN BALANCE THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:CALANDAY
Authorized Official - Last Name:ESMINO-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:321-313-1882
Mailing Address - Street 1:4825 CITRUS BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2202
Mailing Address - Country:US
Mailing Address - Phone:321-313-1882
Mailing Address - Fax:
Practice Address - Street 1:2425 N COURTENAY PKWY STE 3
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4100
Practice Address - Country:US
Practice Address - Phone:321-313-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty