1740314848 NPI number — BODIES IN BALANCE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740314848 NPI number — BODIES IN BALANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODIES IN BALANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740314848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4151 SW FWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77027-7312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-395-6308
Provider Business Mailing Address Fax Number:
713-395-6307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 SW FWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-7312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-395-6308
Provider Business Practice Location Address Fax Number:
713-395-6307
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
QUOC
Authorized Official Middle Name:
THAI
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
713-395-6308

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  8166 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8X6200 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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