NPIMap

Organization Active NPI

The Balance Lab Physical Therapy and Fitness PC

  • Physical Therapist
  • Santa Monica, CA
National Provider Identifier
1215435847
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT39349 Issued in CA
Legal business name
THE BALANCE LAB PHYSICAL THERAPY AND FITNESS PC
Practice address
2924 Wilshire Blvd
Santa Monica, CA 90403
Phone
(480) 729-2925
NPI assigned
Jan 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Justin Ross Sandberg, DPTNPI 1598014326
Title
Owner
Phone
(480) 729-2925

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT39349 CA Primary

Addresses

Primary practice location

2924 Wilshire Blvd
Santa Monica, CA 90403

Mailing address

2818 Santa Monica Blvd
Santa Monica, CA 90404-2410
Phone (480) 729-2925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180417002798 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7315200797 Receives reassigned benefits from 14 practitioners
Practice locations: Santa Monica, CA

National Provider Directory

National Provider Directory

Locations

292 S La Cienega Blvd
Ste 350
Beverly Hills, CA 90211
Phone (480) 729-2925

2818 Santa Monica Blvd
Santa Monica, CA 90404
Phone (424) 272-9589

2924 Wilshire Blvd
Santa Monica, CA 90403
Phone (480) 729-2925

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1215435847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2818 SANTA MONICA BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042410",
            "telephone_number": "480-729-2925",
            "fax_number": "424-272-9599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90403",
            "telephone_number": "480-729-2925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BALANCE LAB PHYSICAL THERAPY AND FITNESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-29",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "SANDBERG",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-729-2925",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT39349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.