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General NPI Number Information
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NPI Number | 1982852968
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Entity Type | Organization
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Legal Business Name | PROBALANCE, INC.
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 08/22/2015
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Provider Practice Location Address
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Address Line | 2213 HARBOR BAY PKWY
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City | ALAMEDA
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State | CA
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Zip | 94502-3026
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Country | US
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Telephone | 510-523-1900
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Fax | 510-523-2673
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Provider Business Mailing Address
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Address Line | 2213 HARBOR BAY PKWY
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City | ALAMEDA
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State | CA
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Zip | 94502-3026
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Country | US
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Telephone | 510-523-1900
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Fax | 510-523-2673
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Authorized Official
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Title or Position | OWNER
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Name | MS. ADA WELLS
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Credential | P.T.
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Telephone | 510-523-1900
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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 | PT-21378
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License Number State | CA
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