Provider Demographics
NPI:1972920031
Name:BODY BALANCE PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:BODY BALANCE PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC LAC
Authorized Official - Phone:812-230-4070
Mailing Address - Street 1:17 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3510
Mailing Address - Country:US
Mailing Address - Phone:812-230-4070
Mailing Address - Fax:888-553-3501
Practice Address - Street 1:17 S 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3510
Practice Address - Country:US
Practice Address - Phone:812-230-4070
Practice Address - Fax:888-553-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies