MEDICARE: BETTER BALANCE, PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician	2005-01611	NC

General Provider Information

NPI Number	:	1770827115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTER BALANCE, PLLC

Provider Business Mailing Address
First Line	:	2425 N CENTER ST
Second Line	:	BOX 302
City	:	HICKORY
State	:	NC
Zip	:	28601-1320
Country	:	US
Telephone Number	:	828-328-9200
Fax Number	:	828-328-9219

Provider Business Practice Location Address
First Line	:	1333 2ND ST NE
Second Line	:	SUITE 300
City	:	HICKORY
State	:	NC
Zip	:	28601-2594
Country	:	US
Telephone Number	:	828-328-9200
Fax Number	:	828-328-9219

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEOFFREY STUART COATES-WYNN
Credential	:	MD
Telephone Number	:	828-328-9200

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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