Provider Demographics
NPI:1710472600
Name:BNB WELLNESS LLC
Entity Type:Organization
Organization Name:BNB WELLNESS LLC
Other - Org Name:BODY IN BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:404-931-7248
Mailing Address - Street 1:4261 FLIPPEN TRL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3927
Mailing Address - Country:US
Mailing Address - Phone:404-931-7248
Mailing Address - Fax:
Practice Address - Street 1:1930 BOBBY JONES DR
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2402
Practice Address - Country:US
Practice Address - Phone:404-931-7248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty