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General NPI Number Information
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NPI Number | 1942454301
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Entity Type | Organization
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Legal Business Name | BALANCED PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 2900 HARRIS ST.
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City | EUREKA
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State | CA
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Zip | 95503
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Country | US
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Telephone | 707-441-0770
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Fax | 707-441-0777
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Provider Business Mailing Address
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Address Line | 2900 HARRIS ST.
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City | EUREKA
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State | CA
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Zip | 95503
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Country | US
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Telephone | 707-441-0770
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Fax | 707-441-0777
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | GAYLE PATRICE
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Credential | P.T.
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Telephone | 707-839-7790
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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 | PT13287
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License Number State | CA
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