Healthcare Provider Details

I. General information

NPI: 1528799830
Provider Name (Legal Business Name): NADIYA MOMIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 06/19/2022
Certification Date: 06/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 CYPRESSWOOD DR
SPRING TX
77379-8691
US

IV. Provider business mailing address

8421 WILLOW LOCH DR
SPRING TX
77379-7551
US

V. Phone/Fax

Practice location:
  • Phone: 284-767-2715
  • Fax:
Mailing address:
  • Phone: 100-000-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: