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General NPI Number Information
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NPI Number | 1134354285
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Entity Type | Organization
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Legal Business Name | LIFE BALANCE PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 190 HENDERSONVILLE RD STE 95
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City | ASHEVILLE
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State | NC
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Zip | 28803-2680
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Country | US
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Telephone | 202-255-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 6419 OUTER BRIDGE LN
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City | CHARLOTTE
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State | NC
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Zip | 28270-1730
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Country | US
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Telephone | 202-255-7409
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | GRACE LEUNG STOCKDALE
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Credential | MSPT
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Telephone | 202-255-7409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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