Organization
BALANCE REHABILITATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY J RIVELLO (OFFICE/BILLING MANAGER)
(949) 465-9500
Entity
Organization
Contact information
Practice address
23832 ROCKFIELD BLVD STE 160, LAKE FOREST, CA 92630-2820
(949) 465-9500
(949) 465-9506
Mailing address
23832 ROCKFIELD BLVD STE 160, LAKE FOREST, CA 92630-2820
(949) 465-9500
(949) 465-9506
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT24624
CA
225100000X
Physical Therapist
PT29999
CA
225100000X
Physical Therapist
PT30004
CA
2251X0800X
Orthopedic Physical Therapist
Primary
PT24606
CA
225X00000X
Occupational Therapist
OT142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08672Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
08/30/2006
Last updated
06/05/2018
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