Healthcare Provider Details

I. General information

NPI: 1174911135
Provider Name (Legal Business Name): BACK TO BALANCE PHYSICAL THERAPY AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30101 TOWN CENTER DR SUITE 103
LAGUNA NIGUEL CA
92677-5006
US

IV. Provider business mailing address

29911 NIGUEL RD UNIT 6704
LAGUNA NIGUEL CA
92607-2428
US

V. Phone/Fax

Practice location:
  • Phone: 949-444-9917
  • Fax:
Mailing address:
  • Phone: 949-444-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDY S. WOOD
Title or Position: PRESIDENT/ CEO
Credential: PT, DPT, GCS
Phone: 949-444-9917