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General NPI Number Information
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NPI Number | 1134449762
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Entity Type | Organization
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Legal Business Name | A BALANCED LIFE CENTER PLLC
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Dates
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Enumeration Date | 06/05/2010
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Last Update Date | 06/05/2010
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Provider Practice Location Address
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Address Line | 100 W 11TH ST SUITE B
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City | VANCOUVER
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State | WA
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Zip | 98660-3352
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Country | US
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Telephone | 360-693-2112
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Fax | 360-735-9058
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Provider Business Mailing Address
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Address Line | 100 W 11TH ST SUITE B
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City | VANCOUVER
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State | WA
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Zip | 98660-3352
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Country | US
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Telephone | 360-693-2112
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Fax | 360-735-9058
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Authorized Official
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Title or Position | MANAGER
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Name | SABRINA A WRIGHT
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Credential | LMP
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Telephone | 360-693-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 00020739
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License Number State | WA
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