MEDICARE: BALANCE CENTER OF LAS VEGAS, 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	225100000X	Physical Therapist	0947	NV

General Provider Information

NPI Number	:	1104021419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE CENTER OF LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	1750 N BUFFALO DR
Second Line	:	UNIT 104-434
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2672
Country	:	US
Telephone Number	:	702-341-0606
Fax Number	:	702-341-1040

Provider Business Practice Location Address
First Line	:	321 N BUFFALO DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0324
Country	:	US
Telephone Number	:	702-341-0606
Fax Number	:	702-341-1040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BETH SROKA
Credential	:
Telephone Number	:	702-341-0606

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/27/2007

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