MEDICARE: BALANCED LIFE, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1477256683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED LIFE, INC.

Provider Business Mailing Address
First Line	:	7087 CAMINO DEGRAZIA UNIT 148
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7087 CAMINO DEGRAZIA UNIT 148
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7826
Country	:	US
Telephone Number	:	516-690-0685
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAULA LEONTI
Credential	:	DPT
Telephone Number	:	516-690-0685

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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