Provider Demographics
NPI:1194213637
Name:MOVEMENT SOLUTIONS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOVEMENT SOLUTIONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-494-2090
Mailing Address - Street 1:4112 LOS FELIZ BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2342
Mailing Address - Country:US
Mailing Address - Phone:323-851-7876
Mailing Address - Fax:
Practice Address - Street 1:6711 FOREST LAWN DR STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1032
Practice Address - Country:US
Practice Address - Phone:323-851-7876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty