Provider Demographics
NPI:1205974870
Name:IN BALANCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:IN BALANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:970-403-5939
Mailing Address - Street 1:34 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4731
Mailing Address - Country:US
Mailing Address - Phone:970-403-5939
Mailing Address - Fax:877-839-2679
Practice Address - Street 1:575 RIVERGATE LN UNIT 109
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7488
Practice Address - Country:US
Practice Address - Phone:970-403-5939
Practice Address - Fax:877-839-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7984261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803579Medicare PIN