Provider Demographics
NPI:1265674105
Name:MOMENTUM PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:508-422-0101
Mailing Address - Street 1:141 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-422-0101
Mailing Address - Fax:508-422-0102
Practice Address - Street 1:141 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-422-0101
Practice Address - Fax:508-422-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA148230OtherHARVARD PILGRIM HEALTH CARE
MA652395OtherTUFTS HEALTH PLAN
9903359OtherAETNA
MA0013793OtherMEDICARE PTAN
MAY61564OtherBCBS