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General NPI Number Information
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NPI Number | 1235095969
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Entity Type | Organization
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Legal Business Name | BALANCE-VITA PLLC
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 12 W WILLOW GROVE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3952
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Country | US
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Telephone | 267-270-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 12 W WILLOW GROVE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MATTHEW WATTO
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Credential | MD
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Telephone | 267-270-2446
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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