MEDICARE: BODY BALANCE AND BEYOND 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1902077753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY BALANCE AND BEYOND INC

Provider Business Mailing Address
First Line	:	146 SOUTH BLVD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-2462
Country	:	US
Telephone Number	:	650-638-1988
Fax Number	:	650-638-0788

Provider Business Practice Location Address
First Line	:	146 SOUTH BLVD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-2462
Country	:	US
Telephone Number	:	650-638-1988
Fax Number	:	650-638-0788

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BLANKA OPUSTILOVA
Credential	:
Telephone Number	:	650-638-1988

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	11/18/2011

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