Provider Demographics
NPI:1063874816
Name:ESSENTIAL BALANCE PHYSICAL THERAPY & MASSAGE PA
Entity type:Organization
Organization Name:ESSENTIAL BALANCE PHYSICAL THERAPY & MASSAGE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, LMT
Authorized Official - Phone:954-224-0521
Mailing Address - Street 1:11321 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9156
Mailing Address - Country:US
Mailing Address - Phone:561-701-8002
Mailing Address - Fax:561-708-5757
Practice Address - Street 1:11321 49TH ST N
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-9156
Practice Address - Country:US
Practice Address - Phone:561-701-8002
Practice Address - Fax:561-708-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty