Healthcare Provider Details

I. General information

NPI: 1104284223
Provider Name (Legal Business Name): INBALANCE ACUPUNCTURE PT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E UNION ST
PASADENA CA
91101-1719
US

IV. Provider business mailing address

615 E UNION ST
PASADENA CA
91101-1719
US

V. Phone/Fax

Practice location:
  • Phone: 626-551-1108
  • Fax:
Mailing address:
  • Phone: 626-551-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT35876
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAC14972
License Number StateCA

VIII. Authorized Official

Name: LORY YEH
Title or Position: DIRECTOR
Credential: PT, DPT, OCS, LAC
Phone: 626-551-1108