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Organization

BALANCE AND FALL PREVENTION CLINIC, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARY THERESA STOUT PT,DPT (CEO/THERAPIST)
(570) 672-2277
Entity
Organization

Contact information

Practice address
173 S MARKET ST, ELYSBURG, PA 17824-9757
(570) 672-2277
Mailing address
173 S MARKET ST, ELYSBURG, PA 17824-9757
(570) 672-2277

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT001749E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
412246
MEDICARE PTAN
PA
Enumeration date
01/13/2012
Last updated
01/13/2012
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