Healthcare Provider Details

I. General information

NPI: 1609243328
Provider Name (Legal Business Name): MOMENTUM PHYSICAL & SPORTS REHABILITATION LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 COMMERCE PARK BLVD
TAMPA FL
33647-2600
US

IV. Provider business mailing address

12952 BANDERA RD STE 107
HELOTES TX
78023-4733
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-6369
  • Fax: 813-615-5467
Mailing address:
  • Phone: 210-372-9600
  • Fax: 210-598-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000