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General NPI Number Information
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NPI Number | 1912143660
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Entity Type | Organization
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Legal Business Name | BALANCE PEDIATRICS, INC.
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 12/31/2008
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Provider Practice Location Address
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Address Line | 317 ROSE ST
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City | PECKVILLE
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State | PA
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Zip | 18452-2231
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Country | US
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Telephone | 570-383-7096
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Fax |
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Provider Business Mailing Address
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Address Line | 317 ROSE ST
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City | PECKVILLE
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State | PA
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Zip | 18452-2231
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Country | US
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Telephone | 570-383-7096
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AMY TREMBACK-BALL
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Credential | PHD
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Telephone | 570-383-7096
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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 | PT010998L
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License Number State | PA
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