# PHYSIO BALANCE AND SPORTS PERFORMANCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255812715
- **Authorized official:** VERRELLE LEE WYATT PT, DPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (330) 942-3316

## Contact information

- **Practice address:** 1587 BOETTLER RD STE 140, UNIONTOWN, OH 44685
- **Practice address phone:** (330) 687-6891
- **Practice address fax:** (330) 362-2623
- **Mailing address:** 1587 BOETTLER RD STE 140, UNIONTOWN, OH 44685-7823
- **Mailing address phone:** (330) 687-6891
- **Mailing address fax:** (330) 362-2623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251S0007X | Sports Physical Therapist | — | NULL | Yes |
| 2251S0007X | Sports Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2018
- **Last updated:** 07/16/2020