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General NPI Number Information
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NPI Number | 1689813180
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Entity Type | Organization
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Legal Business Name | ABSOLUTE BODY BALANCE, LLC
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Dates
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Enumeration Date | 02/07/2009
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Last Update Date | 02/07/2009
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Provider Practice Location Address
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Address Line | 6612 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6523
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Country | US
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Telephone | 919-841-9344
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Fax |
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Provider Business Mailing Address
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Address Line | 6612 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-6523
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Country | US
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Telephone | 919-841-9344
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY A PERRY
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Credential | LMBT
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Telephone | 919-841-9344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 02848
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License Number State | NC
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