Healthcare Provider Details

I. General information

NPI: 1871648279
Provider Name (Legal Business Name): MOMENTUM AGENCIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST SUITE 100
TORRANCE CA
90501
US

IV. Provider business mailing address

6430 INDEPENDENCE AVE
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax: 310-328-3094
Mailing address:
  • Phone: 818-782-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI LEE ANDERSON
Title or Position: PRESIDENT AND CHEF EXECUTIVE OFFICE
Credential:
Phone: 818-782-2211