Provider Demographics
NPI:1255935888
Name:BACK TO BALANCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BACK TO BALANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:HEBERT-RUGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-232-5186
Mailing Address - Street 1:545 HOOKSETT RD UNIT 20
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2654
Mailing Address - Country:US
Mailing Address - Phone:603-232-5186
Mailing Address - Fax:603-622-3199
Practice Address - Street 1:545 HOOKSETT RD UNIT 20
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2654
Practice Address - Country:US
Practice Address - Phone:603-232-5186
Practice Address - Fax:603-622-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy