Provider Demographics
NPI:1760979702
Name:MOMENTUM PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:843-990-0286
Mailing Address - Street 1:721 LONG POINT RD STE 406
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8298
Mailing Address - Country:US
Mailing Address - Phone:843-990-0286
Mailing Address - Fax:843-352-7818
Practice Address - Street 1:721 LONG POINT RD STE 406
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8298
Practice Address - Country:US
Practice Address - Phone:843-352-7800
Practice Address - Fax:843-352-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherPHYSICAL THERAPY CLINIC