Provider Demographics
NPI:1558722397
Name:IN BALANCE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:IN BALANCE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:SAMARA
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-948-6609
Mailing Address - Street 1:3455 WILKENS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5213
Mailing Address - Country:US
Mailing Address - Phone:443-948-6609
Mailing Address - Fax:443-948-6610
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:443-948-6609
Practice Address - Fax:443-948-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19223261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy