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General NPI Number Information
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NPI Number | 1154871408
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Entity Type | Organization
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Legal Business Name | BACK INTO BALANCE, INC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 1211 GAR HWY
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City | SWANSEA
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State | MA
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Zip | 02777-4225
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Country | US
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Telephone | 508-672-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 GAR HWY
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City | SWANSEA
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State | MA
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Zip | 02777-4225
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Country | US
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Telephone | 508-672-2227
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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 | MRS. DANA MARIE GIGLIO
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Credential | MASSAGE THERAPIST
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Telephone | 508-672-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 534
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License Number State | MA
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