Provider Demographics
NPI:1902077753
Name:BODY BALANCE AND BEYOND INC
Entity type:Organization
Organization Name:BODY BALANCE AND BEYOND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPUSTILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-638-1988
Mailing Address - Street 1:146 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2462
Mailing Address - Country:US
Mailing Address - Phone:650-638-1988
Mailing Address - Fax:650-638-0788
Practice Address - Street 1:146 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2462
Practice Address - Country:US
Practice Address - Phone:650-638-1988
Practice Address - Fax:650-638-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF386AMedicare PIN