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General NPI Number Information
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NPI Number | 1609932474
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Entity Type | Individual
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Provider Name | DAVID NONYELUM MOMAH PT
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 1111 MIDLAND AVE 1G
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City | BRONXVILLE
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State | NY
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Zip | 10708-6337
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Country | US
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Telephone | 718-210-6637
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Fax | 678-253-5914
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Provider Business Mailing Address
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Address Line | 1100 MOCCASIN TRL
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City | LOGANVILLE
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State | GA
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Zip | 30052-4736
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Country | US
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Telephone | 770-602-1617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT006102
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License Number State | GA
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