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General NPI Number Information
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NPI Number | 1245243880
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Entity Type | Organization
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Legal Business Name | BACK-N-BALANCE PHYSICAL THERAPY AND REHAB SPECIALISTS
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 2934 CENTRAL ST SUITE 2C
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City | EVANSTON
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State | IL
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Zip | 60201-1296
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Country | US
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Telephone | 847-424-0130
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Fax | 847-424-0127
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Provider Business Mailing Address
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Address Line | PO BOX 3497
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City | STURTEVANT
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State | WI
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Zip | 53177-0300
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Country | US
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Telephone | 877-552-2996
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Fax | 866-245-8064
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Authorized Official
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Title or Position | CO-OWNER
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Name | LARRY BRIAND
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Credential |
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Telephone | 877-552-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | IL
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