Healthcare Provider Details

I. General information

NPI: 1588890065
Provider Name (Legal Business Name): IN BALANCE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR STE 210
OWINGS MILLS MD
21117
US

IV. Provider business mailing address

21 CROSSROADS DR STE 210
OWINGS MILLS MD
21117-5483
US

V. Phone/Fax

Practice location:
  • Phone: 443-948-6609
  • Fax: 443-948-6610
Mailing address:
  • Phone: 443-948-6609
  • Fax: 443-948-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JODI SAMARA BERGER
Title or Position: DIRECTOR
Credential: MPT
Phone: 443-948-6609