Provider Demographics
NPI:1699207274
Name:VESTIBULAR LINC LLC
Entity Type:Organization
Organization Name:VESTIBULAR LINC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:BELLEFEUILLE
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:706-927-5033
Mailing Address - Street 1:921 HARMONY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9618
Mailing Address - Country:US
Mailing Address - Phone:706-927-5033
Mailing Address - Fax:
Practice Address - Street 1:921 HARMONY RD STE 2
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9618
Practice Address - Country:US
Practice Address - Phone:706-927-5033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation