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General NPI Number Information
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NPI Number | 1780826529
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Entity Type | Organization
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Legal Business Name | PURE BALANCE HOLISTIC HEALING LLC
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 3 FRONT ST STE 408
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City | ROLLINSFORD
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State | NH
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Zip | 03869-7001
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Country | US
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Telephone | 603-387-3347
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Fax | 603-343-4708
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Provider Business Mailing Address
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Address Line | 3 FRONT ST STE 408 PO BOX 492
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City | ROLLINSFORD
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State | NH
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Zip | 03869-7001
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Country | US
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Telephone | 603-387-3347
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Fax | 603-343-4708
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | DR. KRYSTAL L COUTURE
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Credential | PT
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Telephone | 603-387-3347
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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 | 3158
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License Number State | NH
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