Organization
PRO BALANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GILGIA PRUMBS PT (MEMBER)
(423) 246-7272
Entity
Organization
Contact information
Practice address
2408 FORT HENRY DR, KINGSPORT, TN 37664-3708
(423) 246-7272
(423) 246-2803
Mailing address
2408 FORT HENRY DR, KINGSPORT, TN 37664-3708
(423) 246-7272
(423) 246-2803
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT2424
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3654861
—
TN
Enumeration date
09/19/2014
Last updated
09/19/2014
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