Provider Demographics
NPI:1174170161
Name:BALANCED OUTPATIENT THERAPY LLC
Entity type:Organization
Organization Name:BALANCED OUTPATIENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-306-9750
Mailing Address - Street 1:1142 JENSEN DR # 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-5872
Mailing Address - Country:US
Mailing Address - Phone:757-965-9942
Mailing Address - Fax:757-222-1103
Practice Address - Street 1:1142 JENSEN DR # 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5872
Practice Address - Country:US
Practice Address - Phone:757-965-9942
Practice Address - Fax:757-222-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty