Provider Demographics
NPI:1518581131
Name:EQUILIBRIUM PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:EQUILIBRIUM PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:616-345-3778
Mailing Address - Street 1:11971 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9610
Mailing Address - Country:US
Mailing Address - Phone:616-345-3778
Mailing Address - Fax:855-670-0383
Practice Address - Street 1:11971 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9610
Practice Address - Country:US
Practice Address - Phone:616-345-3778
Practice Address - Fax:855-670-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083784821OtherNPI