Healthcare Provider Details

I. General information

NPI: 1194213637
Provider Name (Legal Business Name): MOVEMENT SOLUTIONS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 FOREST LAWN DR STE 104
LOS ANGELES CA
90068-1032
US

IV. Provider business mailing address

4112 LOS FELIZ BLVD APT 5
LOS ANGELES CA
90027-2342
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-7876
  • Fax:
Mailing address:
  • Phone: 323-851-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL BALLENTINE
Title or Position: OWNER
Credential: DPT
Phone: 917-494-2090