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General NPI Number Information
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NPI Number | 1487845400
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM BALANCE PERFORMANCE CENTER PHYSICAL THERAPY A PROF. CORP.
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 1673 DONLON ST STE 201
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City | VENTURA
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State | CA
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Zip | 93003-5668
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Country | US
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Telephone | 805-339-9718
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Fax | 805-339-9728
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Provider Business Mailing Address
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Address Line | 1673 DONLON ST STE 201
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City | VENTURA
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State | CA
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Zip | 93003-5668
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Country | US
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Telephone | 805-339-9718
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Fax | 805-339-9728
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY M. GRIFFIN
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Credential | M.S.,P.T.
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Telephone | 805-339-9718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 27784
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License Number State | CA
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