MEDICARE: KIDS ON THE MOVE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070010430	IL

General Provider Information

NPI Number	:	1164543518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS ON THE MOVE INC.

Provider Business Mailing Address
First Line	:	1711 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	773-931-4072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	773-931-4072
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELIZABETH ANN URSO
Credential	:	DPT
Telephone Number	:	773-931-4072

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	04/14/2009

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