Provider Demographics
NPI:1568066371
Name:BIO BALANCE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BIO BALANCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-855-1875
Mailing Address - Street 1:22521 GLENMOOR HTS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3523
Mailing Address - Country:US
Mailing Address - Phone:248-345-3117
Mailing Address - Fax:248-471-0838
Practice Address - Street 1:23023 ORCHARD LAKE RD STE C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3267
Practice Address - Country:US
Practice Address - Phone:248-345-3117
Practice Address - Fax:248-471-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy