Healthcare Provider Details

I. General information

NPI: 1518083344
Provider Name (Legal Business Name): BALANCED PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W WEAVER ST SUITE 103
CARRBORO NC
27510-2084
US

IV. Provider business mailing address

304 W WEAVER ST SUITE 103
CARRBORO NC
27510-2084
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-0240
  • Fax: 919-942-0280
Mailing address:
  • Phone: 919-942-0240
  • Fax: 919-942-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2827
License Number StateNC

VIII. Authorized Official

Name: BRIAN RALPH BEATTY
Title or Position: BUSINESS OWNER
Credential: PT
Phone: 919-942-0240