Provider Demographics
NPI:1043332851
Name:DYNAMIC EQUILIBRIUM, INC.
Entity Type:Organization
Organization Name:DYNAMIC EQUILIBRIUM, INC.
Other - Org Name:BALANCE INSTITUTE OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:DREHS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-577-7333
Mailing Address - Street 1:7440 N SHADELAND AVE
Mailing Address - Street 2:#130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2029
Mailing Address - Country:US
Mailing Address - Phone:317-577-7333
Mailing Address - Fax:317-577-7330
Practice Address - Street 1:7440 N SHADELAND AVE
Practice Address - Street 2:#130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2029
Practice Address - Country:US
Practice Address - Phone:317-577-7333
Practice Address - Fax:317-577-7330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC EQUILIBRIUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002810A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05002810AOtherINDIANA PROFESSIONAL LICENSING AGENCY
IN200114780AMedicaid
IN200114780AMedicaid