Healthcare Provider Details

I. General information

NPI: 1407200801
Provider Name (Legal Business Name): BALANCEOT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 NW 71ST ST
SEATTLE WA
98117-6146
US

IV. Provider business mailing address

2821 NW MARKET ST STE E
SEATTLE WA
98107-5815
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-2262
  • Fax:
Mailing address:
  • Phone: 206-706-0063
  • Fax: 206-508-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number60240376
License Number StateWA

VIII. Authorized Official

Name: MS. KELLY ANN CLANCY
Title or Position: OWNER
Credential: OTR/L
Phone: 206-706-0063