Provider Demographics
NPI:1720094329
Name:MOMENTUM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:970-377-1422
Mailing Address - Street 1:1939 WILMINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6299
Mailing Address - Country:US
Mailing Address - Phone:970-377-1422
Mailing Address - Fax:970-377-1839
Practice Address - Street 1:1939 WILMINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6299
Practice Address - Country:US
Practice Address - Phone:970-377-1422
Practice Address - Fax:970-377-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC489068Medicare ID - Type UnspecifiedMEDICARE GROUP ID