=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033310545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCE FROM WITHIN, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7514 E MONTEREY WAY SUITE 6
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-6900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-300-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13440 N 13TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-300-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | JENNIFER MAGARY
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 602-300-2945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT-01524P
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------