Provider Demographics
NPI:1528648995
Name:ADVANCED BALANCE PHYSICAL THERAPY CO.
Entity type:Organization
Organization Name:ADVANCED BALANCE PHYSICAL THERAPY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-833-0300
Mailing Address - Street 1:1921 N GAFFEY ST STE I
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1264
Mailing Address - Country:US
Mailing Address - Phone:310-833-0300
Mailing Address - Fax:310-833-0306
Practice Address - Street 1:1921 N GAFFEY ST STE I
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1264
Practice Address - Country:US
Practice Address - Phone:310-833-0300
Practice Address - Fax:310-833-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy