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General NPI Number Information
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NPI Number | 1659915056
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Entity Type | Organization
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Legal Business Name | BALANCED PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 200 MACOMB DAILY DR
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5800
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Country | US
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Telephone | 248-752-5286
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Fax |
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Provider Business Mailing Address
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Address Line | 31500 NORTHWESTERN HWY STE 135
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2518
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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 | OWNER
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Name | ROBERT LITZENBURG
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Credential | P.T.
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Telephone | 248-752-5286
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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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