Provider Demographics
NPI:1639172653
Name:MOMENTUM PHYSICAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-257-3422
Mailing Address - Street 1:80 S PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4635
Mailing Address - Country:US
Mailing Address - Phone:901-257-3422
Mailing Address - Fax:901-257-3423
Practice Address - Street 1:80 S PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4635
Practice Address - Country:US
Practice Address - Phone:901-257-3422
Practice Address - Fax:901-257-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001467225100000X, 225100000X
TNPT0000006606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4004523OtherBLUECROSS BLUESHIELD
TN0446657Medicaid
TN446657Medicare Oscar/Certification