MEDICARE: BODYBALANCE PT TWIN FALLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1043657828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODYBALANCE PT TWIN FALLS LLC

Provider Business Mailing Address
First Line	:	1896 CANDLERIDGE DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-8302
Country	:	US
Telephone Number	:	208-734-6172
Fax Number	:

Provider Business Practice Location Address
First Line	:	657 BLUE LAKES BLVD N
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4036
Country	:	US
Telephone Number	:	208-934-9011
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DENNIS MCARTHUR
Credential	:
Telephone Number	:	208-934-9011

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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