Provider Demographics
NPI:1760152268
Name:MOMENTUM PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:TASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-400-3328
Mailing Address - Street 1:5507 MILL RACE CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6441
Mailing Address - Country:US
Mailing Address - Phone:801-400-3328
Mailing Address - Fax:
Practice Address - Street 1:5507 MILL RACE CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6441
Practice Address - Country:US
Practice Address - Phone:801-400-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy