Healthcare Provider Details

I. General information

NPI: 1093115750
Provider Name (Legal Business Name): BALANCED PHYSICAL THERAPY & FITNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2014
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W HOSPITALITY LN STE 113
SAN BERNARDINO CA
92408-3350
US

IV. Provider business mailing address

164 W HOSPITALITY LN STE 113
SAN BERNARDINO CA
92408-3350
US

V. Phone/Fax

Practice location:
  • Phone: 909-229-7980
  • Fax:
Mailing address:
  • Phone: 909-229-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT34098
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CELINA WANDA SHELTON
Title or Position: OWNER/PRESIDENT
Credential: P.T.
Phone: 909-229-7980