Provider Demographics
NPI:1730297177
Name:LIFE IN BALANCE LLC
Entity Type:Organization
Organization Name:LIFE IN BALANCE LLC
Other - Org Name:LIFE IN BALANCE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:269-687-9594
Mailing Address - Street 1:410 1/2 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2238
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:135 W EDISON RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3142
Practice Address - Country:US
Practice Address - Phone:574-255-8060
Practice Address - Fax:574-255-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006117A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232410Medicare PIN