Healthcare Provider Details

I. General information

NPI: 1285944199
Provider Name (Legal Business Name): BALANCED BODIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MIDWEST ROAD SUITE 302
OAKBROOK IL
60523-1343
US

IV. Provider business mailing address

2001 MIDWEST ROAD SUITE 302
OAKBROOK IL
60523-1343
US

V. Phone/Fax

Practice location:
  • Phone: 630-279-0032
  • Fax: 630-279-1833
Mailing address:
  • Phone: 630-279-0032
  • Fax: 630-279-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070010605
License Number StateIL

VIII. Authorized Official

Name: MS. MEEJUNG JANE PARK
Title or Position: OWNER
Credential: MPT
Phone: 630-748-9670