Provider Demographics
NPI:1770537235
Name:ESSENTIAL BALANCE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:ESSENTIAL BALANCE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-924-5700
Mailing Address - Street 1:25 MITCHELL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2007
Mailing Address - Country:US
Mailing Address - Phone:415-924-5700
Mailing Address - Fax:415-924-5723
Practice Address - Street 1:25 MITCHELL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2007
Practice Address - Country:US
Practice Address - Phone:415-924-5700
Practice Address - Fax:415-924-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609826965OtherNPI
CA1205886561OtherNPI
CA1609826965OtherNPI