Healthcare Provider Details

I. General information

NPI: 1487845400
Provider Name (Legal Business Name): EQUILIBRIUM BALANCE PERFORMANCE CENTER PHYSICAL THERAPY A PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 DONLON ST STE 201
VENTURA CA
93003-5668
US

IV. Provider business mailing address

1673 DONLON ST STE 201
VENTURA CA
93003-5668
US

V. Phone/Fax

Practice location:
  • Phone: 805-339-9718
  • Fax: 805-339-9728
Mailing address:
  • Phone: 805-339-9718
  • Fax: 805-339-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 27784
License Number StateCA

VIII. Authorized Official

Name: AMY M. GRIFFIN
Title or Position: PRESIDENT
Credential: M.S.,P.T.
Phone: 805-339-9718