Provider Demographics
NPI:1295992477
Name:BALANCE FOR LIFE CENTER LLC
Entity type:Organization
Organization Name:BALANCE FOR LIFE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAMIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-264-1010
Mailing Address - Street 1:291 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3883
Mailing Address - Country:US
Mailing Address - Phone:801-264-1010
Mailing Address - Fax:801-264-1027
Practice Address - Street 1:291 E 4500 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3883
Practice Address - Country:US
Practice Address - Phone:801-264-1010
Practice Address - Fax:801-264-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty