Provider Demographics
NPI:1720350895
Name:BALANCED BODY-ORTHOPEDIC PHYSICAL THERAPY & FITNESS TRAINING, LLC
Entity Type:Organization
Organization Name:BALANCED BODY-ORTHOPEDIC PHYSICAL THERAPY & FITNESS TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAYLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-749-6281
Mailing Address - Street 1:3705 W MEMORIAL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1512
Mailing Address - Country:US
Mailing Address - Phone:405-749-6281
Mailing Address - Fax:405-936-6496
Practice Address - Street 1:3705 W MEMORIAL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1512
Practice Address - Country:US
Practice Address - Phone:405-749-6281
Practice Address - Fax:405-936-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty