Provider Demographics
NPI:1134449762
Name:A BALANCED LIFE CENTER PLLC
Entity type:Organization
Organization Name:A BALANCED LIFE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-693-2112
Mailing Address - Street 1:100 W 11TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3352
Mailing Address - Country:US
Mailing Address - Phone:360-693-2112
Mailing Address - Fax:360-735-9058
Practice Address - Street 1:100 W 11TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3352
Practice Address - Country:US
Practice Address - Phone:360-693-2112
Practice Address - Fax:360-735-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00020739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty