Provider Demographics
NPI:1083498851
Name:MOMENTUM AGENCIES
Entity Type:Organization
Organization Name:MOMENTUM AGENCIES
Other - Org Name:MOMENTUM PEDIATRIC THERAPY NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:APPLICATIONS AND SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-328-0276
Mailing Address - Street 1:1815 W 213TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2852
Mailing Address - Country:US
Mailing Address - Phone:310-807-4510
Mailing Address - Fax:310-328-3094
Practice Address - Street 1:1815 W 213TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2852
Practice Address - Country:US
Practice Address - Phone:310-807-4510
Practice Address - Fax:310-328-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871648279OtherMULTI DISCIPLINARY FACILITY- OT, PT, SP, EARLY INTERVENTION, HEAD START