MEDICARE: MOMENTUM PHYSICAL THERAPY

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
1	225100000X	Physical Therapist	24774	CA

General Provider Information

NPI Number	:	1760547467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 350
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-721-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 350
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-721-2955
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, CLINICAL DIRECTOR
Name	:	TANYA LYNN DOUGHERTY
Credential	:	MPT
Telephone Number	:	310-721-2955

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1306827324 — CHRISTINE CHOI KIM M.D.
Practice Location Address:

11500 W OLYMPIC BLVD , SUITE 480
LOS ANGELES, CA
90064-1524

Practice Phone: 310-477-4727
Practice Fax:

1952371973 — DAVID ESTEBAN TOURGEMAN M.D.
Practice Location Address:

11500 W OLYMPIC BLVD , SUITE 504
LOS ANGELES, CA
90064-1524

Practice Phone: 310-481-0881
Practice Fax: 310-481-9017

1982617569 — JOAN SCHMIDT ORTHOPEDIC PHYSICAL THERAPY
Practice Location Address:

11500 W OLYMPIC BLVD # 636
LOS ANGELES, CA
90064-1524

Practice Phone: 310-996-0085
Practice Fax: 310-996-1064

1861505992 — STEVE DEITELBAUM MSW, LCSW
Practice Location Address:

11500 W OLYMPIC BLVD , LOS ANGELES
LOS ANGELES, CA
90064-1524

Practice Phone: 310-726-3444
Practice Fax:

1821187006 — DR. BONNIE HELENE TUCKER PH.D.
Practice Location Address:

11500 W OLYMPIC BLVD , SUITE 500
LOS ANGELES, CA
90064-1524

Practice Phone: 310-473-5363
Practice Fax: 310-478-6698

1962545236 — AMY GABRIELLE GERIAK MPT
Practice Location Address:

11500 W OLYMPIC BLVD , SUITE 350
LOS ANGELES, CA
90064-1524

Practice Phone: 310-473-8287
Practice Fax: 310-477-3909

Directions to “MOMENTUM PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.