Provider Demographics
NPI:1124498464
Name:TOTAL BALANCE REHABILITATION LLC
Entity type:Organization
Organization Name:TOTAL BALANCE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEQUAI
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-615-2195
Mailing Address - Street 1:3696 CRIOLLO DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2221
Mailing Address - Country:US
Mailing Address - Phone:757-615-2195
Mailing Address - Fax:757-689-0206
Practice Address - Street 1:3696 CRIOLLO DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-2221
Practice Address - Country:US
Practice Address - Phone:757-615-2195
Practice Address - Fax:757-689-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0105006790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty