Provider Demographics
NPI:1972757466
Name:BODIES IN BALANCE HEALING ARTS LLC
Entity type:Organization
Organization Name:BODIES IN BALANCE HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:OTTERSBERG-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:719-406-8777
Mailing Address - Street 1:126 W D ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4414
Mailing Address - Country:US
Mailing Address - Phone:719-544-0168
Mailing Address - Fax:719-544-7221
Practice Address - Street 1:126 W D ST STE 100B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4414
Practice Address - Country:US
Practice Address - Phone:719-544-0168
Practice Address - Fax:719-544-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation