Provider Demographics
NPI:1609595057
Name:BALANCE AND CONCUSSION THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:BALANCE AND CONCUSSION THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:551-888-2282
Mailing Address - Street 1:440 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2626
Mailing Address - Country:US
Mailing Address - Phone:551-888-2282
Mailing Address - Fax:
Practice Address - Street 1:1086 TEANECK RD STE 3E
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4855
Practice Address - Country:US
Practice Address - Phone:551-888-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty