Provider Demographics
NPI:1700037173
Name:BALANCE PEDIATRIC DEVELOPMENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:BALANCE PEDIATRIC DEVELOPMENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBACK-BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:570-840-8356
Mailing Address - Street 1:12 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1130
Mailing Address - Country:US
Mailing Address - Phone:570-840-8356
Mailing Address - Fax:
Practice Address - Street 1:12 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433-1130
Practice Address - Country:US
Practice Address - Phone:570-840-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010998L225100000X
PAOC003375L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty