MEDICARE: MOMENTUM PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225XE1200X	Ergonomics Occupational Therapist
2	225XH1200X	Hand Occupational Therapist
3	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT146460	OTHER		BLUE SHIELD
2	937082	OTHER	CA	CIGNA
3	7092476	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1942282405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 612260
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95161-2260
Country	:	US
Telephone Number	:	877-325-2776
Fax Number	:	408-945-4011

Provider Business Practice Location Address
First Line	:	3718 MCDONALD AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804
Country	:	US
Telephone Number	:	510-965-0811
Fax Number	:	510-965-0815

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ANNE LASSON
Credential	:
Telephone Number	:	408-570-0510

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	10/08/2007

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Directions to “MOMENTUM PHYSICAL THERAPY ” Practice Location

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