Provider Demographics
NPI:1669833687
Name:BALANCE DYNAMICS PT LLC
Entity Type:Organization
Organization Name:BALANCE DYNAMICS PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:203-856-5460
Mailing Address - Street 1:75 ROSEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-856-5460
Mailing Address - Fax:
Practice Address - Street 1:6527 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1385
Practice Address - Country:US
Practice Address - Phone:203-856-5460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty