Provider Demographics
NPI:1033543798
Name:EQUIMOTION, INC
Entity Type:Organization
Organization Name:EQUIMOTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:SAC
Authorized Official - Phone:608-632-4459
Mailing Address - Street 1:10750 GAGE LN
Mailing Address - Street 2:
Mailing Address - City:SOLDIERS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:54655-8564
Mailing Address - Country:US
Mailing Address - Phone:608-632-4459
Mailing Address - Fax:608-638-7429
Practice Address - Street 1:10750 GAGE LN
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-8564
Practice Address - Country:US
Practice Address - Phone:608-632-4459
Practice Address - Fax:608-638-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15790-131261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821362831Medicaid