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General NPI Number Information
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NPI Number | 1811982747
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Entity Type | Organization
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Legal Business Name | BODY IN BALANCE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 222 ACACIA ST
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City | FAIRFIELD
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State | CA
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Zip | 94533-3800
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Country | US
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Telephone | 707-421-2095
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Fax | 707-434-9725
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Provider Business Mailing Address
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Address Line | PO BOX 1072
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City | FRANKLIN
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State | TN
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Zip | 37065-1072
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Country | US
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Telephone | 209-576-0888
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Fax | 209-576-0913
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOBBY ISMAIL
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Credential | DPT
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Telephone | 209-353-1988
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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 |
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License Number State |
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