NPIMap

Organization Active NPI

Pro Balance LLC

  • Physical Therapy Clinic/Center
  • Kingsport, TN
National Provider Identifier
1700288974
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT2424 Issued in TN
Legal business name
PRO BALANCE LLC
Practice address
2408 Fort Henry Dr
Kingsport, TN 37664-3708
Phone
(423) 246-7272
Fax
(423) 246-2803
NPI assigned
Sep 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Authorized official

Name
Gilgia Prumbs, PTNPI 1003874249
Title
Member
Phone
(423) 246-7272

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 Therapy Clinic/Center 261QP2000X PT2424 TN Primary

Addresses

Primary practice location

2408 Fort Henry Dr
Kingsport, TN 37664-3708

Mailing address

2408 Fort Henry Dr
Kingsport, TN 37664-3708
Phone (423) 246-7272

Other identifiers 1

IdentifierTypeStateIssuer
3654861MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1700288974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 FORT HENRY DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376643708",
            "telephone_number": "423-246-7272",
            "fax_number": "423-246-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 FORT HENRY DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376643708",
            "telephone_number": "423-246-7272",
            "fax_number": "423-246-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO BALANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "PRUMBS",
        "authorized_official_first_name": "GILGIA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "423-246-7272",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TN",
            "license": "PT2424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3654861",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.