Provider Demographics
NPI:1770738056
Name:BALANCE BASICS, LLC
Entity type:Organization
Organization Name:BALANCE BASICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:480-703-1084
Mailing Address - Street 1:2202 E CATHY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3943
Mailing Address - Country:US
Mailing Address - Phone:480-703-1084
Mailing Address - Fax:480-248-7758
Practice Address - Street 1:4360 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8638
Practice Address - Country:US
Practice Address - Phone:480-703-1084
Practice Address - Fax:480-248-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2643261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation