MEDICARE: MID AMERICA BALANCE INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1417458241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID AMERICA BALANCE INSTITUTE INC

Provider Business Mailing Address
First Line	:	4900 S ARROWHEAD DR STE B
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6990
Country	:	US
Telephone Number	:	816-795-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 NE 91ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3329
Country	:	US
Telephone Number	:	816-246-1456
Fax Number	:

Authorized Official
Title or Position	:	OWNER, MANAGER
Name	:	MICHAEL LEE WOODWARD
Credential	:	MPT
Telephone Number	:	816-795-6999

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/27/2018

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