Provider Demographics
NPI:1740735646
Name:MOVEMENT SPECIALISTS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MOVEMENT SPECIALISTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD, DPT, PCS
Authorized Official - Phone:309-645-2062
Mailing Address - Street 1:6823 N IRON WOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:IL
Mailing Address - Zip Code:61528-9420
Mailing Address - Country:US
Mailing Address - Phone:309-645-2062
Mailing Address - Fax:
Practice Address - Street 1:6823 N IRON WOOD DR
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:IL
Practice Address - Zip Code:61528-9420
Practice Address - Country:US
Practice Address - Phone:309-645-2062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016907252Y00000X
IL160007581252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency