Provider Demographics
NPI:1538458674
Name:TEAM BALANCE PAIN MANAGEMENT CLINIC
Entity Type:Organization
Organization Name:TEAM BALANCE PAIN MANAGEMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOTTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:814-290-6029
Mailing Address - Street 1:500 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1321
Mailing Address - Country:US
Mailing Address - Phone:814-290-6029
Mailing Address - Fax:814-762-8141
Practice Address - Street 1:500 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1321
Practice Address - Country:US
Practice Address - Phone:814-290-6029
Practice Address - Fax:814-762-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty