Provider Demographics
NPI:1942454301
Name:BALANCED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BALANCED PHYSICAL THERAPY
Other - Org Name:INNER BALANCED PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-839-7790
Mailing Address - Street 1:2900 HARRIS ST.
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503
Mailing Address - Country:US
Mailing Address - Phone:707-441-0770
Mailing Address - Fax:707-441-0777
Practice Address - Street 1:2900 HARRIS ST.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-441-0770
Practice Address - Fax:707-441-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT207751Medicare PIN
CAOPT207751Medicare UPIN