Healthcare Provider Details

I. General information

NPI: 1043657828
Provider Name (Legal Business Name): BODYBALANCE PT TWIN FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 BLUE LAKES BLVD N
TWIN FALLS ID
83301-4036
US

IV. Provider business mailing address

1896 CANDLERIDGE DR
TWIN FALLS ID
83301-8302
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-9011
  • Fax:
Mailing address:
  • Phone: 208-734-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS MCARTHUR
Title or Position: MANAGER
Credential:
Phone: 208-934-9011