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General NPI Number Information
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NPI Number | 1194235580
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Entity Type | Organization
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Legal Business Name | IN BALANCE IN CONTROL, L.L.C.
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 1402 W MAYFIELD RD SUITE 420
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City | ARLINGTON
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State | TX
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Zip | 76015
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Country | US
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Telephone | 214-536-2955
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Fax |
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Provider Business Mailing Address
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Address Line | 4621 S COOPER STREET SUITE 131-348
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City | ARLINGTON
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State | TX
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Zip | 75017-5815
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Country | US
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Telephone | 214-536-2955
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Fax |
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Authorized Official
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Title or Position | LOC/MASSAGE THERAPIST
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Name | MR. KENNETH EUGENE FREY II
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Credential | LMT
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Telephone | 214-536-2955
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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 | MT112652
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License Number State | TX
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