Healthcare Provider Details

I. General information

NPI: 1346802451
Provider Name (Legal Business Name): MOMENTA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 N STATE ST
BELLINGHAM WA
98225-4605
US

IV. Provider business mailing address

PO BOX 2281
BELLINGHAM WA
98227-2281
US

V. Phone/Fax

Practice location:
  • Phone: 360-207-4488
  • Fax: 360-207-3310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JACQUELINE MARIE BERG
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 425-466-8004