Provider Demographics
NPI:1982872685
Name:BALANCE PRO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BALANCE PRO PHYSICAL THERAPY PC
Other - Org Name:MANUAL PHYSICAL THERAPY CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRISEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKALEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-745-5550
Mailing Address - Street 1:418 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3206
Mailing Address - Country:US
Mailing Address - Phone:718-745-5550
Mailing Address - Fax:718-745-5551
Practice Address - Street 1:418 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3206
Practice Address - Country:US
Practice Address - Phone:718-745-5550
Practice Address - Fax:718-745-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08291Medicare PIN