Healthcare Provider Details

I. General information

NPI: 1639693963
Provider Name (Legal Business Name): BALANCE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date: 05/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W SAN CARLOS WAY
CHANDLER AZ
85248
US

IV. Provider business mailing address

643 W SAN CARLOS WAY
CHANDLER AZ
85248-5173
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-0766
  • Fax:
Mailing address:
  • Phone: 480-251-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8041
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KOKI K AMIN
Title or Position: OWNER - MANAGING MEMBER
Credential: DPT, MPT
Phone: 480-900-7549