Provider Demographics
NPI:1952194698
Name:MOVING FORWARD PEDIATRIC THERAPY
Entity type:Organization
Organization Name:MOVING FORWARD PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JINGFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-301-8937
Mailing Address - Street 1:3 VIGILANCE CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1223
Mailing Address - Country:US
Mailing Address - Phone:630-205-1266
Mailing Address - Fax:
Practice Address - Street 1:3 VIGILANCE CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1223
Practice Address - Country:US
Practice Address - Phone:630-205-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty