Provider Demographics
NPI:1619728623
Name:WELL-BALANCED PHYSICAL THERAPY L.LC.
Entity Type:Organization
Organization Name:WELL-BALANCED PHYSICAL THERAPY L.LC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-305-1478
Mailing Address - Street 1:1885 RUSTIC DRIVE
Mailing Address - Street 2:APT 106
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-305-1478
Mailing Address - Fax:
Practice Address - Street 1:1885 RUSTIC DRIVE
Practice Address - Street 2:APT 106
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-305-1478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty