Healthcare Provider Details

I. General information

NPI: 1508317694
Provider Name (Legal Business Name): BALANCE SALON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COLLEGE HWY
SOUTHWICK MA
01077-9813
US

IV. Provider business mailing address

535 COLLEGE HWY PO BOX 1092
SOUTHWICK MA
01077-9813
US

V. Phone/Fax

Practice location:
  • Phone: 413-569-9550
  • Fax: 413-566-7235
Mailing address:
  • Phone: 413-569-9550
  • Fax: 413-566-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN C MANOLAKIS
Title or Position: OWNER
Credential:
Phone: 413-569-9550