Provider Demographics
NPI:1609577188
Name:EXPERIENCE MOMENTUM, INC - MILL CREEK
Entity Type:Organization
Organization Name:EXPERIENCE MOMENTUM, INC - MILL CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ-NOWLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-776-0803
Mailing Address - Street 1:4030 ALDERWOOD MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6763
Mailing Address - Country:US
Mailing Address - Phone:425-776-0803
Mailing Address - Fax:425-776-0813
Practice Address - Street 1:16709 9TH AVE SE
Practice Address - Street 2:STE E
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-967-5605
Practice Address - Fax:425-776-0803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPERIENCE MOMENTUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty