Provider Demographics
NPI:1952337404
Name:THE BALANCE CENTER, LLC
Entity Type:Organization
Organization Name:THE BALANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOUCKHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:913-792-7279
Mailing Address - Street 1:14346 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2987
Mailing Address - Country:US
Mailing Address - Phone:913-681-0146
Mailing Address - Fax:913-681-0140
Practice Address - Street 1:14346 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2987
Practice Address - Country:US
Practice Address - Phone:913-681-0146
Practice Address - Fax:913-681-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01611261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS23584049OtherBCBS