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General NPI Number Information
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NPI Number | 1497409023
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Entity Type | Organization
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Legal Business Name | THE BALANCED MOMTALITY WOMEN'S HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 190 CENTRAL PARK SQ STE 214A
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4004
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Country | US
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Telephone | 505-803-2142
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 36TH ST
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City | LOS ALAMOS
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State | NM
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Zip | 87544-2146
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Country | US
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Telephone | 505-803-2142
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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 | DR. DESIREE CASSELL
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Credential | DPT
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Telephone | 505-803-2142
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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 |
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