Healthcare Provider Details

I. General information

NPI: 1295992477
Provider Name (Legal Business Name): BALANCE FOR LIFE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 E 4500 S
MURRAY UT
84107-3883
US

IV. Provider business mailing address

291 E 4500 S
MURRAY UT
84107-3883
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-1010
  • Fax: 801-264-1027
Mailing address:
  • Phone: 801-264-1010
  • Fax: 801-264-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG A BLAMIRES
Title or Position: MBR
Credential:
Phone: 801-264-1010