Progressive Balance Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3069 Issued in AR

Legal business name

PROGRESSIVE BALANCE PHYSICAL THERAPY LLC

Practice address

1706 NW Mystic Ave
Bentonville, AR 72712-8094

Phone

(479) 372-8783

NPI assigned

May 22, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Lynn Vincenzo, PT, MPH, CHES, GCS

Title

Owner

Phone

(479) 372-8783

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400716800000",
    "number": "1558773671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 NW MYSTIC AVE",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727128094",
            "telephone_number": "479-372-8783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 NW MYSTIC AVE",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727128094",
            "telephone_number": "479-372-8783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE BALANCE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2014-05-22",
        "status": "A",
        "authorized_official_last_name": "VINCENZO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-372-8783",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, MPH, CHES, GCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "3069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.