Provider Demographics
NPI:1740690627
Name:BALANCED BODY REHABILITATION LLC
Entity type:Organization
Organization Name:BALANCED BODY REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-503-7173
Mailing Address - Street 1:111 DEAN DR STE 1N
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2762
Mailing Address - Country:US
Mailing Address - Phone:201-503-7173
Mailing Address - Fax:201-503-7177
Practice Address - Street 1:111 DEAN DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2764
Practice Address - Country:US
Practice Address - Phone:201-503-7173
Practice Address - Fax:201-503-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty