Provider Demographics
NPI:1518083344
Name:BALANCED PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BALANCED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-942-0240
Mailing Address - Street 1:304 W WEAVER ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2084
Mailing Address - Country:US
Mailing Address - Phone:919-942-0240
Mailing Address - Fax:919-942-0280
Practice Address - Street 1:304 W WEAVER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2084
Practice Address - Country:US
Practice Address - Phone:919-942-0240
Practice Address - Fax:919-942-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012UROtherBLUE CROSS BLUE SHIELD
NC012UROtherBLUE CROSS BLUE SHIELD