Organization
BALANCED VITALITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE PORTER (OFFICE MANAGER)
(307) 577-4225
Entity
Organization
Contact information
Practice address
1125 E 2ND ST, CASPER, WY 82601-2903
(307) 577-4225
(307) 577-4229
Mailing address
1125 E 2ND ST, CASPER, WY 82601-2903
(307) 577-4225
(307) 577-4229
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013083740
—
WY
05
—
1477894756
—
WY
Enumeration date
08/15/2022
Last updated
08/15/2022
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