Healthcare Provider Details

I. General information

NPI: 1689304834
Provider Name (Legal Business Name): MOMENTUM REHAB CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WARD HILL AVE
BRADFORD MA
01835-5896
US

IV. Provider business mailing address

80 WOOD LN
ACTON MA
01720-4529
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-8000
  • Fax:
Mailing address:
  • Phone: 718-666-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL VISHNEVETSKY LIN
Title or Position: FOUNDER AND CEO
Credential: MD
Phone: 718-666-7990