Organization
BODY BALANCE GOLF & PHYSICAL THERAPY, LLC
Active
Other names
Body Balance for Performance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JOHN WIEBER LPT (OWNER)
(952) 888-9549
Entity
Organization
Contact information
Practice address
2070 W 96TH ST, BLOOMINGTON, MN 55431-2517
(952) 888-9549
(952) 703-3481
Mailing address
2070 W 96TH ST, BLOOMINGTON, MN 55431-2517
(952) 888-9549
(952) 703-3481
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
394M1BO
BLUE CROSS & BLUE SHIELD
—
Enumeration date
06/27/2005
Last updated
02/28/2008
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