Provider Demographics
NPI:1487905477
Name:BALANCE REHAB PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BALANCE REHAB PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:703-660-1366
Mailing Address - Street 1:7202 FORDSON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-7217
Mailing Address - Country:US
Mailing Address - Phone:703-660-1366
Mailing Address - Fax:
Practice Address - Street 1:7202 FORDSON RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-7217
Practice Address - Country:US
Practice Address - Phone:703-660-1366
Practice Address - Fax:703-660-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205237261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy