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General NPI Number Information
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NPI Number | 1093115750
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Entity Type | Organization
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Legal Business Name | BALANCED PHYSICAL THERAPY & FITNESS, PC
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Dates
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Enumeration Date | 09/01/2014
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN STE 113
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3350
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Country | US
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Telephone | 909-229-7980
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Fax |
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Provider Business Mailing Address
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Address Line | 164 W HOSPITALITY LN STE 113
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3350
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Country | US
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Telephone | 909-229-7980
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CELINA WANDA SHELTON
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Credential | P.T.
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Telephone | 909-229-7980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT34098
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License Number State | CA
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