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General NPI Number Information
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NPI Number | 1174911135
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Entity Type | Organization
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Legal Business Name | BACK TO BALANCE PHYSICAL THERAPY AND WELLNESS, PC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 30101 TOWN CENTER DR SUITE 103
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5006
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Country | US
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Telephone | 949-444-9917
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Fax |
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Provider Business Mailing Address
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Address Line | 29911 NIGUEL RD UNIT 6704
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-2428
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Country | US
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Telephone | 949-444-9917
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | DR. WENDY S. WOOD
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Credential | PT, DPT, GCS
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Telephone | 949-444-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric 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 | 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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