Basic Information
| Provider Information | |||||||||
| NPI: | 1518083344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALANCED PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 W WEAVER ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275102084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199420240 | ||||||||
| FaxNumber: | 9199420280 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 W WEAVER ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275102084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199420240 | ||||||||
| FaxNumber: | 9199420280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 09/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEATTY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | RALPH | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9199420240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2827 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 012UR | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER |