Provider Demographics
NPI:1851835938
Name:BALANCED BODYWORKS LLC
Entity Type:Organization
Organization Name:BALANCED BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBERLANGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-602-2324
Mailing Address - Street 1:485 N 450 E
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1540
Mailing Address - Country:US
Mailing Address - Phone:801-602-2324
Mailing Address - Fax:
Practice Address - Street 1:485 N 450 E
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1540
Practice Address - Country:US
Practice Address - Phone:801-602-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health