Healthcare Provider Details

I. General information

NPI: 1295654168
Provider Name (Legal Business Name): BALANCE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6182 CREEKSIDE CT
GRAND BLANC MI
48439-7445
US

IV. Provider business mailing address

6182 CREEKSIDE CT
GRAND BLANC MI
48439-7445
US

V. Phone/Fax

Practice location:
  • Phone: 810-394-1615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. EKTA AMITKUMAR SHAH
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 810-394-1615