Provider Demographics
NPI:1740968197
Name:BALANCED BODYWORKS
Entity type:Organization
Organization Name:BALANCED BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-519-8049
Mailing Address - Street 1:2217 E TUDOR ROAD, SUITE 33
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1068
Mailing Address - Country:US
Mailing Address - Phone:907-519-8049
Mailing Address - Fax:907-782-4148
Practice Address - Street 1:2217 E TUDOR ROAD, SUITE 33
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1068
Practice Address - Country:US
Practice Address - Phone:907-519-8049
Practice Address - Fax:907-782-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty