Provider Demographics
NPI:1972643138
Name:EQUINOX, INC
Entity Type:Organization
Organization Name:EQUINOX, INC
Other - Org Name:EQUINOX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-479-3800
Mailing Address - Street 1:3677 COLLEGE RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3712
Mailing Address - Country:US
Mailing Address - Phone:907-479-3800
Mailing Address - Fax:907-479-9195
Practice Address - Street 1:3677 COLLEGE RD
Practice Address - Street 2:SUITE 13
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3712
Practice Address - Country:US
Practice Address - Phone:907-479-3800
Practice Address - Fax:907-479-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK207554261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1700961851OtherINDV NPI #
AKPT0306Medicaid
AK1912082090OtherINDV NPI #
AK1972643138OtherNPI # EQUINOX, INC
AKPT1607Medicaid
AK1306090766OtherNPI INDV#
AKPT9414Medicaid
AK1215013263OtherINDV NPI #
AK1326122722OtherINDV NPI #
AKPT0665Medicaid
AKPT1807Medicaid
AKKOOOOWCPGCOtherMEDICARE PTAN#
AKKOOOOWCPGCOtherMEDICARE PTAN#
AK00WCPGCBMedicare ID - Type UnspecifiedINDV MEDICARE #
AK1912082090OtherINDV NPI #
AK1215013263OtherINDV NPI #
AKPT1607Medicaid