Provider Demographics
NPI:1780826529
Name:PURE BALANCE HOLISTIC HEALING LLC
Entity Type:Organization
Organization Name:PURE BALANCE HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-387-3347
Mailing Address - Street 1:3 FRONT ST STE 408
Mailing Address - Street 2:PO BOX 492
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-7001
Mailing Address - Country:US
Mailing Address - Phone:603-387-3347
Mailing Address - Fax:603-343-4708
Practice Address - Street 1:3 FRONT ST STE 408
Practice Address - Street 2:
Practice Address - City:ROLLINSFORD
Practice Address - State:NH
Practice Address - Zip Code:03869-7001
Practice Address - Country:US
Practice Address - Phone:603-387-3347
Practice Address - Fax:603-343-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3158261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942301965OtherNPI INDIVIDUAL PROVIDER IDENTIFIER