Provider Demographics
NPI:1730787094
Name:MOVEMENT SYSTEM INSTITUTE PHYSIOTHERAPY INC
Entity type:Organization
Organization Name:MOVEMENT SYSTEM INSTITUTE PHYSIOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKSETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-777-0722
Mailing Address - Street 1:508 GLENWOOD RD APT 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1572
Mailing Address - Country:US
Mailing Address - Phone:747-777-0722
Mailing Address - Fax:
Practice Address - Street 1:508 GLENWOOD RD APT 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1572
Practice Address - Country:US
Practice Address - Phone:747-777-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT291137OtherPHYSICAL THERAPY BOARD OF CALIFORNIA