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NPI Code Detail

MEDICARE: MOMENTUM PHYSICAL REHABILITATION, LLC

MEDICARE: MOMENTUM PHYSICAL REHABILITATION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT0000001467TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14004523OTHERTNBLUECROSS BLUESHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639172653
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOMENTUM PHYSICAL REHABILITATION, LLC
Provider Business Mailing Address
First Line : 80 S PRESCOTT ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-4635
Country : US
Telephone Number : 901-257-3422
Fax Number : 901-257-3423
Provider Business Practice Location Address
First Line : 80 S PRESCOTT ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-4635
Country : US
Telephone Number : 901-257-3422
Fax Number : 901-257-3423
Authorized Official
Title or Position : SYSTEMS ADMINISTRATOR
Name : MRS. KRISTI L. PESCE
Credential :
Telephone Number : 901-257-3422
Provider Enumeration Date : 05/23/2005
Last Update Date : 05/15/2023

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Practice Location Address:
80 SOUTH PRESCOTT STREET , MOMENTUM PHYSICAL REHABILITATION, LLC
MEMPHIS, TN
38111-4635
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Practice Fax: 901-257-3423
1972987139 — DERRICK RICHARD TORRES PT
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1154841377 — KELSEY CLINE JOHNSON DPT
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80 S PRESCOTT ST
MEMPHIS, TN
38111-4635
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1487119483 — HALEY ELIZABETH OLBINA PTA
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1003699729 — THOMAS PEYTON WALSH DPT
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1386511871 — LIVING IN COMFORT HOME CARE, INC
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Directions to “MOMENTUM PHYSICAL REHABILITATION, LLC ” Practice Location

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