Healthcare Provider Details

I. General information

NPI: 1457049231
Provider Name (Legal Business Name): IN BALANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 THEATRE DR STE 500
ST AUGUSTINE FL
32086-3131
US

IV. Provider business mailing address

84 THEATRE DR STE 500
ST AUGUSTINE FL
32086-3131
US

V. Phone/Fax

Practice location:
  • Phone: 904-770-2552
  • Fax:
Mailing address:
  • Phone: 904-770-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH R VERNA
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 484-459-0780