Healthcare Provider Details

I. General information

NPI: 1043840846
Provider Name (Legal Business Name): MOMENTUM THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SPANISH OAK RD
STEPHENS CITY VA
22655-4042
US

IV. Provider business mailing address

115 CREEKSIDE LN
WINCHESTER VA
22602-2429
US

V. Phone/Fax

Practice location:
  • Phone: 703-431-3202
  • Fax: 540-301-0751
Mailing address:
  • Phone: 703-431-3202
  • Fax: 540-301-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HUSSEIN IBRAHIM
Title or Position: PRESIDENT/CEO
Credential: DPT
Phone: 703-333-5288