Provider Demographics
NPI:1689813180
Name:ABSOLUTE BODY BALANCE, LLC
Entity type:Organization
Organization Name:ABSOLUTE BODY BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:919-841-9344
Mailing Address - Street 1:6612 SIX FORKS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6523
Mailing Address - Country:US
Mailing Address - Phone:919-841-9344
Mailing Address - Fax:
Practice Address - Street 1:6612 SIX FORKS RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6523
Practice Address - Country:US
Practice Address - Phone:919-841-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty