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General NPI Number Information
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NPI Number | 1255979035
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Entity Type | Organization
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Legal Business Name | BALANCED PHYSICAL THERAPY & SPORTS PERFORMANCE
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 6520 FALLS OF NEUSE RD STE 110
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City | RALEIGH
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State | NC
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Zip | 27615-6849
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Country | US
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Telephone | 919-803-1037
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 KINLAWTON PL
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City | RALEIGH
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State | NC
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Zip | 27614-9867
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Country | US
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Telephone | 717-615-2704
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | AMANDA FULTINEER
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Credential | PT
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Telephone | 919-803-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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