Provider Demographics
NPI:1659934768
Name:BALANCED LIFE SPA
Entity Type:Organization
Organization Name:BALANCED LIFE SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ELBY
Authorized Official - Last Name:MCCOOL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-214-4448
Mailing Address - Street 1:1010A 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1718
Mailing Address - Country:US
Mailing Address - Phone:360-214-4448
Mailing Address - Fax:
Practice Address - Street 1:1010A 6TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1718
Practice Address - Country:US
Practice Address - Phone:360-610-7830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty