Healthcare Provider Details

I. General information

NPI: 1902712417
Provider Name (Legal Business Name): BALANCING BOOTS THERAPEUTIC RIDING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BURNING BUSH PL
PALM COAST FL
32137-8811
US

IV. Provider business mailing address

14 BURNING BUSH PL
PALM COAST FL
32137-8811
US

V. Phone/Fax

Practice location:
  • Phone: 386-237-2219
  • Fax:
Mailing address:
  • Phone: 386-237-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELE GOURLEY
Title or Position: OWNER
Credential: PATH ESMHL CTRI
Phone: 386-237-2219