Healthcare Provider Details

I. General information

NPI: 1952558918
Provider Name (Legal Business Name): MOMENTUM PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DRIVE SUITE 305
GAINESVILLE VA
20155
US

IV. Provider business mailing address

7915 LAKE MANASSAS DRIVE SUITE 305
GAINESVILLE VA
20155
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-0248
  • Fax: 571-248-0250
Mailing address:
  • Phone: 571-248-0248
  • Fax: 571-248-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204856
License Number StateVA

VIII. Authorized Official

Name: JENNIFER HEILMAN
Title or Position: OWNER/PT
Credential:
Phone: 571-248-0248