Healthcare Provider Details

I. General information

NPI: 1972931608
Provider Name (Legal Business Name): BODIES IN BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-2716
US

IV. Provider business mailing address

8730 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-2716
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2800
  • Fax: 310-275-2886
Mailing address:
  • Phone: 310-275-2800
  • Fax: 310-275-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT18721
License Number StateCA

VIII. Authorized Official

Name: ADAM TANNER-HILL
Title or Position: PRESIDENT/MANAGER
Credential: PT
Phone: 310-275-2800