Provider Demographics
NPI:1134354285
Name:LIFE BALANCE PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:LIFE BALANCE PHYSICAL THERAPY & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG STOCKDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:202-255-7409
Mailing Address - Street 1:6419 OUTER BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1730
Mailing Address - Country:US
Mailing Address - Phone:202-255-7409
Mailing Address - Fax:
Practice Address - Street 1:190 HENDERSONVILLE RD STE 95
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2680
Practice Address - Country:US
Practice Address - Phone:202-255-7409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy