Provider Demographics
NPI:1215474457
Name:MOTION FOR LIFE PHYSICAL THERAPY AND INTEGRATIVE MOVEMENT INC
Entity type:Organization
Organization Name:MOTION FOR LIFE PHYSICAL THERAPY AND INTEGRATIVE MOVEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MLYNARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-240-1725
Mailing Address - Street 1:4513 LINCOLN AVE
Mailing Address - Street 2:105A
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1289
Mailing Address - Country:US
Mailing Address - Phone:630-240-1725
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:4513 LINCOLN AVE
Practice Address - Street 2:105A
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1289
Practice Address - Country:US
Practice Address - Phone:630-240-1725
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN070003812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty