Provider Demographics
NPI:1649580341
Name:CENTER FOR BALANCE, DIZZINESS AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CENTER FOR BALANCE, DIZZINESS AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:POZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-364-0262
Mailing Address - Street 1:2206 S SEACREST BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6519
Mailing Address - Country:US
Mailing Address - Phone:561-364-0262
Mailing Address - Fax:561-364-0292
Practice Address - Street 1:2206 S SEACREST BLVD
Practice Address - Street 2:STE 1
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6519
Practice Address - Country:US
Practice Address - Phone:561-364-0262
Practice Address - Fax:561-364-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84428261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty