Basic Information
| Provider Information | |||||||||
| NPI: | 1609243328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOMENTUM PHYSICAL & SPORTS REHABILITATION LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8627 CINNAMON CREEK DR | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107828555 | ||||||||
| FaxNumber: | 2105980432 | ||||||||
| Practice Location | |||||||||
| Address1: | 17200 COMMERCE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136156369 | ||||||||
| FaxNumber: | 8136155467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2015 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.