MEDICARE: EQUILIBRIUM PHYSICAL THERAPY, LLC

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	018764	NY

General Provider Information

NPI Number	:	1811961667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUILIBRIUM PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	261 E 78TH ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-1216
Country	:	US
Telephone Number	:	212-472-5820
Fax Number	:	646-559-9617

Provider Business Practice Location Address
First Line	:	261 E 78TH ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-1216
Country	:	US
Telephone Number	:	212-472-5820
Fax Number	:	646-559-9617

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW ROME
Credential	:	DPT
Telephone Number	:	212-472-5820

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	01/08/2020

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