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General NPI Number Information
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NPI Number | 1700288974
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Entity Type | Organization
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Legal Business Name | PRO BALANCE LLC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 2408 FORT HENRY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-3708
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Country | US
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Telephone | 423-246-7272
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Fax | 423-246-2803
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Provider Business Mailing Address
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Address Line | 2408 FORT HENRY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-3708
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Country | US
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Telephone | 423-246-7272
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Fax | 423-246-2803
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Authorized Official
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Title or Position | MEMBER
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Name | GILGIA PRUMBS
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Credential | PT
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Telephone | 423-246-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT2424
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License Number State | TN
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