Healthcare Provider Details

I. General information

NPI: 1396880514
Provider Name (Legal Business Name): BACK IN BALANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1001
US

IV. Provider business mailing address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1001
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-7876
  • Fax:
Mailing address:
  • Phone: 323-851-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: ERIN MCGUIRE
Title or Position: PRESIDENT, CEO
Credential: PT, OCS
Phone: 323-851-7876