Healthcare Provider Details

I. General information

NPI: 1720528219
Provider Name (Legal Business Name): BODY IN BALANCE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RIVER LANDING DR SUITE 103
DANIEL ISLAND SC
29492-2500
US

IV. Provider business mailing address

1261 SMYTHE ST
DANIEL ISLAND SC
29492-8371
US

V. Phone/Fax

Practice location:
  • Phone: 301-704-7888
  • Fax:
Mailing address:
  • Phone: 301-704-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5484
License Number StateSC

VIII. Authorized Official

Name: SUSAN KIMBERLY CHALELA
Title or Position: PRESIDENT
Credential: PT
Phone: 301-704-7888