Provider Demographics
NPI:1508253691
Name:INBALANCE PT LLC
Entity Type:Organization
Organization Name:INBALANCE PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-2987
Mailing Address - Street 1:36397 N GANTZEL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140
Mailing Address - Country:US
Mailing Address - Phone:480-567-2987
Mailing Address - Fax:480-347-0240
Practice Address - Street 1:36397 N GANTZEL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140
Practice Address - Country:US
Practice Address - Phone:480-567-2987
Practice Address - Fax:480-347-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ488563Medicaid
AZ488563Medicaid