Provider Demographics
NPI:1740666296
Name:BALANCED CARE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BALANCED CARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-754-8025
Mailing Address - Street 1:1110 S TALBOT ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 S TALBOT ST
Practice Address - Street 2:UNIT 5
Practice Address - City:ST MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2606
Practice Address - Country:US
Practice Address - Phone:410-745-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty