Provider Demographics
NPI:1164087169
Name:CLE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:CLE PHYSICAL THERAPY, PLLC
Other - Org Name:EQUILIBRIUM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ECKENHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-593-5104
Mailing Address - Street 1:PO BOX 3295
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-3295
Mailing Address - Country:US
Mailing Address - Phone:404-593-5104
Mailing Address - Fax:970-965-0633
Practice Address - Street 1:56 EDWARDS VILLAGE BLVD UNIT 204
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7804
Practice Address - Country:US
Practice Address - Phone:404-593-5104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty