Provider Demographics
NPI:1013327873
Name:BODY BALANCE LLC
Entity Type:Organization
Organization Name:BODY BALANCE LLC
Other - Org Name:BODY BALANCE LAKEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-261-8699
Mailing Address - Street 1:505 COPPERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3840
Mailing Address - Country:US
Mailing Address - Phone:512-261-8699
Mailing Address - Fax:512-261-2237
Practice Address - Street 1:1602 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5160
Practice Address - Country:US
Practice Address - Phone:251-226-1869
Practice Address - Fax:512-261-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11115242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611681Medicare UPIN