Healthcare Provider Details

I. General information

NPI: 1386306447
Provider Name (Legal Business Name): B BALANCED PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GILFORD AVE BLDG 1B2
GILFORD NH
03249-7500
US

IV. Provider business mailing address

416 CHERRY VALLEY RD
GILFORD NH
03249-7840
US

V. Phone/Fax

Practice location:
  • Phone: 603-832-6555
  • Fax: 603-293-4360
Mailing address:
  • Phone: 603-832-6555
  • Fax: 603-293-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN GUERIN
Title or Position: OWNER
Credential: PT
Phone: 603-832-6555