# BODY BALANCE GOLF & PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Body Balance for Performance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023014859
- **Authorized official:** MR. DAVID JOHN WIEBER LPT (OWNER)
- **Authorized official phone:** (952) 888-9549

## Contact information

- **Practice address:** 2070 W 96TH ST, BLOOMINGTON, MN 55431-2517
- **Practice address phone:** (952) 888-9549
- **Practice address fax:** (952) 703-3481
- **Mailing address:** 2070 W 96TH ST, BLOOMINGTON, MN 55431-2517
- **Mailing address phone:** (952) 888-9549
- **Mailing address fax:** (952) 703-3481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2005
- **Last updated:** 02/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 394M1BO | BLUE CROSS & BLUE SHIELD | — |