Healthcare Provider Details

I. General information

NPI: 1982566469
Provider Name (Legal Business Name): BALANCED BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 W SAHARA AVE STE 101
LAS VEGAS NV
89117-7916
US

IV. Provider business mailing address

7975 W SAHARA AVE STE 101
LAS VEGAS NV
89117-7916
US

V. Phone/Fax

Practice location:
  • Phone: 702-843-0590
  • Fax: 702-441-7080
Mailing address:
  • Phone: 702-843-0590
  • Fax: 702-441-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SEAN CROTTY
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-882-4478