Healthcare Provider Details

I. General information

NPI: 1003426297
Provider Name (Legal Business Name): BAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 18TH ST S
ARLINGTON VA
22204-5141
US

IV. Provider business mailing address

4019 18TH ST S
ARLINGTON VA
22204-5141
US

V. Phone/Fax

Practice location:
  • Phone: 703-967-9981
  • Fax: 571-464-6587
Mailing address:
  • Phone: 703-967-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK EDWARD BAL JR.
Title or Position: OWNER
Credential: PT, DPT
Phone: 703-967-9981