Provider Demographics
NPI:1659319697
Name:CENTER OF BALANCE, PC
Entity type:Organization
Organization Name:CENTER OF BALANCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:NAULTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-259-7180
Mailing Address - Street 1:1622 W SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5908
Mailing Address - Country:US
Mailing Address - Phone:773-594-0225
Mailing Address - Fax:773-439-2479
Practice Address - Street 1:1622 W SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5908
Practice Address - Country:US
Practice Address - Phone:773-259-7180
Practice Address - Fax:773-439-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-12-17
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
IL212099Medicare PIN