Healthcare Provider Details

I. General information

NPI: 1003891227
Provider Name (Legal Business Name): BALANCED HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 E 16TH ST
SANTA ANA CA
92701-3112
US

IV. Provider business mailing address

1820 E 16TH ST
SANTA ANA CA
92701-3112
US

V. Phone/Fax

Practice location:
  • Phone: 714-855-2223
  • Fax: 714-835-2224
Mailing address:
  • Phone: 714-855-2223
  • Fax: 714-835-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT19635
License Number StateCA

VIII. Authorized Official

Name: MR. DARRIN EUGENE MADOLE
Title or Position: OWNER PHYSICAL THERAPIST
Credential: PT
Phone: 714-835-2223