Provider Demographics
NPI:1942080510
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
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:610-716-1184
Mailing Address - Street 1:1189 HIGHWAY 315 BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6959
Mailing Address - Country:US
Mailing Address - Phone:570-209-9699
Mailing Address - Fax:570-209-9238
Practice Address - Street 1:1189 HIGHWAY 315 BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6959
Practice Address - Country:US
Practice Address - Phone:570-209-9699
Practice Address - Fax:570-209-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty