Healthcare Provider Details

I. General information

NPI: 1750222485
Provider Name (Legal Business Name): HER BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WOODWAY PARK DR
SANDY SPRINGS GA
30350-4543
US

IV. Provider business mailing address

130 WOODWAY PARK DR
SANDY SPRINGS GA
30350-4543
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-6653
  • Fax:
Mailing address:
  • Phone: 616-481-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDY GOLDEN
Title or Position: OWNER
Credential: PT,DPT
Phone: 616-481-6653