Provider Demographics
NPI:1598776296
Name:BALANCE POINT PHYSICAL THERAPY CLINIC LTD.
Entity Type:Organization
Organization Name:BALANCE POINT PHYSICAL THERAPY CLINIC LTD.
Other - Org Name:BALANCE POINT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-873-8356
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:413 MORRIS ST
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0505
Mailing Address - Country:US
Mailing Address - Phone:360-466-7458
Mailing Address - Fax:360-466-1418
Practice Address - Street 1:413 MORRIS ST
Practice Address - Street 2:
Practice Address - City:LACONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-466-7458
Practice Address - Fax:360-466-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7076441Medicaid
WA7076441Medicaid