MEDICARE: DYNAMIC EQUILIBRIUM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05002810A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05002810A	OTHER	IN	INDIANA PROFESSIONAL LICENSING AGENCY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043332851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC EQUILIBRIUM, INC.

Provider Business Mailing Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	#130
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:	317-577-7333
Fax Number	:	317-577-7330

Provider Business Practice Location Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	#130
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:	317-577-7333
Fax Number	:	317-577-7330

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHARON K. DREHS
Credential	:	PT
Telephone Number	:	317-577-7333

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/31/2024

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Directions to “DYNAMIC EQUILIBRIUM, INC. ” Practice Location

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