Provider Demographics
NPI:1922567809
Name:MOVEMENT SYNERGY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MOVEMENT SYNERGY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CSCS
Authorized Official - Phone:630-664-6298
Mailing Address - Street 1:1746 W HURON ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5631
Mailing Address - Country:US
Mailing Address - Phone:630-664-6298
Mailing Address - Fax:312-253-1408
Practice Address - Street 1:2000 N RACINE AVE STE 1000B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7011
Practice Address - Country:US
Practice Address - Phone:630-664-6298
Practice Address - Fax:312-253-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty