Healthcare Provider Details

I. General information

NPI: 1952194698
Provider Name (Legal Business Name): MOVING FORWARD PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VIGILANCE CT
BOLINGBROOK IL
60440-1223
US

IV. Provider business mailing address

3 VIGILANCE CT
BOLINGBROOK IL
60440-1223
US

V. Phone/Fax

Practice location:
  • Phone: 630-205-1266
  • Fax:
Mailing address:
  • Phone: 630-205-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. JINGFANG BALOGA
Title or Position: OWNER
Credential:
Phone: 773-301-8937