Provider Demographics
NPI:1619661824
Name:BE BALANCED MASSAGE LLC
Entity Type:Organization
Organization Name:BE BALANCED MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:217-864-1127
Mailing Address - Street 1:1397 MT ZION PKWY
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1478
Mailing Address - Country:US
Mailing Address - Phone:217-864-1127
Mailing Address - Fax:
Practice Address - Street 1:1397 MT ZION PKWY
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1478
Practice Address - Country:US
Practice Address - Phone:217-864-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center