Provider Demographics
NPI:1295059467
Name:BALANCE MASSAGE AND STRUCTURAL BODYWORK
Entity type:Organization
Organization Name:BALANCE MASSAGE AND STRUCTURAL BODYWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:OFSOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-704-8867
Mailing Address - Street 1:1220 EDGEWATER DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6366
Mailing Address - Country:US
Mailing Address - Phone:407-704-8867
Mailing Address - Fax:
Practice Address - Street 1:1220 EDGEWATER DR STE 7
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6366
Practice Address - Country:US
Practice Address - Phone:407-704-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 21812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty