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General NPI Number Information
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NPI Number | 1184922684
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Entity Type | Organization
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Legal Business Name | MOVEMENT PHYSICAL THERAPY AND WELLNESS PC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 355 E GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60611-5389
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Country | US
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Telephone | 312-587-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 355 E GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60611-5389
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Country | US
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Telephone | 312-587-3432
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAMIT P SHAH
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Credential | DPT
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Telephone | 312-587-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070016139
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License Number State | IL
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