Healthcare Provider Details

I. General information

NPI: 1407234917
Provider Name (Legal Business Name): BALANCED PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7849 TRAMWAY BLVD NE STE A
ALBUQUERQUE NM
87122-2529
US

IV. Provider business mailing address

7849 TRAMWAY BLVD NE STE A
ALBUQUERQUE NM
87122-2529
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-3831
  • Fax: 505-212-0786
Mailing address:
  • Phone: 505-821-3831
  • Fax: 505-212-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3845
License Number StateNM

VIII. Authorized Official

Name: JAMEL ESCH
Title or Position: OWNER/PT
Credential: PT
Phone: 505-485-7468