Provider Demographics
NPI:1306317615
Name:BALANCED FITNESS & HEALTH
Entity type:Organization
Organization Name:BALANCED FITNESS & HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-693-7745
Mailing Address - Street 1:2200 HERITAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2326
Mailing Address - Country:US
Mailing Address - Phone:319-693-7745
Mailing Address - Fax:319-378-6951
Practice Address - Street 1:2200 HERITAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2326
Practice Address - Country:US
Practice Address - Phone:319-693-7745
Practice Address - Fax:319-378-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-12
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty