Provider Demographics
NPI:1093324345
Name:MOTOGENIX CONCIERGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOTOGENIX CONCIERGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-224-8927
Mailing Address - Street 1:111 S MORGAN ST APT 620
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2732
Mailing Address - Country:US
Mailing Address - Phone:708-224-8927
Mailing Address - Fax:
Practice Address - Street 1:111 S MORGAN ST APT 620
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2732
Practice Address - Country:US
Practice Address - Phone:708-224-8927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy