Provider Demographics
NPI:1790400240
Name:BRIGHT BALANCED THERAPY, LLC
Entity Type:Organization
Organization Name:BRIGHT BALANCED THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-729-0387
Mailing Address - Street 1:202A LEWIES CIR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-3127
Mailing Address - Country:US
Mailing Address - Phone:970-729-0387
Mailing Address - Fax:
Practice Address - Street 1:202A LEWIES CIR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-3127
Practice Address - Country:US
Practice Address - Phone:970-729-0387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty