Provider Demographics
NPI:1184337768
Name:WELL BALANCED PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WELL BALANCED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:605-610-8220
Mailing Address - Street 1:5408 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3085
Mailing Address - Country:US
Mailing Address - Phone:605-351-1560
Mailing Address - Fax:
Practice Address - Street 1:2210 W 69TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5614
Practice Address - Country:US
Practice Address - Phone:605-610-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy