Provider Demographics
NPI:1104309426
Name:KIDS IN BALANCE LLC
Entity type:Organization
Organization Name:KIDS IN BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-405-6020
Mailing Address - Street 1:2312 W MEDILL AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3234
Mailing Address - Country:US
Mailing Address - Phone:773-405-6020
Mailing Address - Fax:
Practice Address - Street 1:2312 W MEDILL AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3234
Practice Address - Country:US
Practice Address - Phone:773-405-6020
Practice Address - Fax:877-217-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty