Provider Demographics
NPI:1841656196
Name:MOMENTUM PHYSICAL THERAPY
Entity type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WILLIAMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:307-696-6045
Mailing Address - Street 1:305 E LAKEWAY RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6301
Mailing Address - Country:US
Mailing Address - Phone:307-696-6045
Mailing Address - Fax:307-696-6046
Practice Address - Street 1:305 E LAKEWAY RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6301
Practice Address - Country:US
Practice Address - Phone:307-696-6045
Practice Address - Fax:307-696-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1565261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy