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General NPI Number Information
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NPI Number | 1760715866
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Entity Type | Organization
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Legal Business Name | INBALANCE PT LLC
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 2510 E HUNT HWY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-5206
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Country | US
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Telephone | 480-567-2231
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Fax |
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Provider Business Mailing Address
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Address Line | 270 E HUNT HWY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4962
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Country | US
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Telephone | 480-567-2231
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. RYAN VANCE
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Credential | PT
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Telephone | 480-567-2231
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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 | 5392
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License Number State | AZ
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