Healthcare Provider Details

I. General information

NPI: 1063874816
Provider Name (Legal Business Name): ESSENTIAL BALANCE PHYSICAL THERAPY & MASSAGE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 49TH ST N
ROYAL PALM BEACH FL
33411-9156
US

IV. Provider business mailing address

11321 49TH ST N
ROYAL PALM BEACH FL
33411-9156
US

V. Phone/Fax

Practice location:
  • Phone: 561-701-8002
  • Fax: 561-708-5757
Mailing address:
  • Phone: 561-701-8002
  • Fax: 561-708-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALYSIA PANOS
Title or Position: PRESIDENT
Credential: PT, DPT, LMT
Phone: 954-224-0521