Provider Demographics
NPI:1497090450
Name:MOMENTUM REHABILITATION
Entity Type:Organization
Organization Name:MOMENTUM REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SPERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MBA
Authorized Official - Phone:813-785-6395
Mailing Address - Street 1:305 W ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5115
Mailing Address - Country:US
Mailing Address - Phone:813-785-6395
Mailing Address - Fax:
Practice Address - Street 1:305 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5115
Practice Address - Country:US
Practice Address - Phone:813-785-6395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19301261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy