Provider Demographics
NPI:1740590512
Name:THE BODY-N-BALANCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:THE BODY-N-BALANCE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-645-6529
Mailing Address - Street 1:4734 CARDINAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1908
Mailing Address - Country:US
Mailing Address - Phone:904-645-6529
Mailing Address - Fax:904-645-6540
Practice Address - Street 1:3980 SOUTHSIDE BLVD BLDG 1
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6611
Practice Address - Country:US
Practice Address - Phone:904-645-6529
Practice Address - Fax:904-645-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty