Provider Demographics
NPI:1245870757
Name:BALANCED PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BALANCED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-465-2934
Mailing Address - Street 1:2879 MAJESTIC OAKS LN
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8324
Mailing Address - Country:US
Mailing Address - Phone:904-465-2934
Mailing Address - Fax:904-204-0934
Practice Address - Street 1:2879 MAJESTIC OAKS LN
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8324
Practice Address - Country:US
Practice Address - Phone:904-465-2934
Practice Address - Fax:904-204-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy