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General NPI Number Information
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NPI Number | 1336958040
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Entity Type | Organization
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Legal Business Name | INTEGRATED BALANCE THERAPY PLLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 4030 WAKE FOREST RD STE 349
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City | RALEIGH
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State | NC
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Zip | 27609-0010
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Country | US
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Telephone | 919-400-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 N DUKE ST STE 1
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City | DURHAM
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State | NC
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Zip | 27704-1769
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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 | EMPLOYEE
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Name | MS. ANDREA B MOORE
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Credential |
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Telephone | 254-449-4975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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