Provider Demographics
NPI:1821428418
Name:MOVEVOLUTION, INC
Entity Type:Organization
Organization Name:MOVEVOLUTION, INC
Other - Org Name:MOVEVOLUTION INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SYMISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:718-916-0526
Mailing Address - Street 1:87 FORT GREENE PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1203
Mailing Address - Country:US
Mailing Address - Phone:718-522-2658
Mailing Address - Fax:
Practice Address - Street 1:87 FORT GREENE PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1203
Practice Address - Country:US
Practice Address - Phone:718-522-2658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0227091261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy