Organization Name: | MOMENTUM PT & WELLNESS LTD |
NPI Number: | 1265868814 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TYLER WHITESIDE (PRESIDENT) |
Mailing Address: | 2023 Woodwind Dr Leland |
State: | NC US |
Postal Code: | 284514146 |
Phone Number: | 7039805570 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2013 |
NPI Last Update Date: | 09/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 11905 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |