Provider Demographics
NPI:1932397643
Name:BODY IN BALANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BODY IN BALANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:609-365-8499
Mailing Address - Street 1:314 CENTRAL AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2005
Mailing Address - Country:US
Mailing Address - Phone:609-365-8499
Mailing Address - Fax:609-365-8498
Practice Address - Street 1:314 CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2005
Practice Address - Country:US
Practice Address - Phone:609-365-8499
Practice Address - Fax:609-365-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00915700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100236Medicare PIN