=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861477929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCED PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 10/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 NE 139TH ST STE 102
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-573-3611
-----------------------------------------------------
Fax | 360-573-3880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 NE 139TH ST STE 102
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-573-3611
-----------------------------------------------------
Fax | 360-573-3880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DEBORAH LYNN LEHNER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 360-573-3611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 602153132
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------