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General NPI Number Information
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NPI Number | 1396478087
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Entity Type | Organization
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Legal Business Name | BALANCED BY KATIE PHYSICAL THERAPY YOGA & WELLNESS
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 02/25/2024
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Provider Practice Location Address
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Address Line | 404 CALLE CAMPANERO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6504
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Country | US
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Telephone | 973-723-2651
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Fax |
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Provider Business Mailing Address
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Address Line | 404 CALLE CAMPANERO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6504
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Country | US
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Telephone | 973-723-2651
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHARYN T D'AMATO
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Credential | DPT
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Telephone | 973-723-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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