Provider Demographics
NPI:1871010645
Name:BALANCED THERAPY AND WELLNESS, INC
Entity Type:Organization
Organization Name:BALANCED THERAPY AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANCSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-567-3891
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46361-8231
Mailing Address - Country:US
Mailing Address - Phone:708-567-3891
Mailing Address - Fax:219-879-5416
Practice Address - Street 1:5271 N JOHNSON RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9377
Practice Address - Country:US
Practice Address - Phone:708-567-3891
Practice Address - Fax:219-879-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007382A225100000X
IN31003490A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty