Provider Demographics
NPI:1184458671
Name:MOVEMENT RX LLC
Entity type:Organization
Organization Name:MOVEMENT RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:815-200-8810
Mailing Address - Street 1:1423 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1611
Mailing Address - Country:US
Mailing Address - Phone:815-200-8810
Mailing Address - Fax:
Practice Address - Street 1:1423 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1611
Practice Address - Country:US
Practice Address - Phone:815-200-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy