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General NPI Number Information
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NPI Number | 1750753976
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Entity Type | Organization
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Legal Business Name | MOMENTUM HEALTH PARTNERS PLLC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 4551 BOAT CLUB RD
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City | FORT WORTH
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State | TX
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Zip | 76135-2004
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Country | US
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Telephone | 817-905-4017
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Fax | 888-507-6727
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Provider Business Mailing Address
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Address Line | 100 ALEDO GROVE CT
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City | FORT WORTH
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State | TX
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Zip | 76126-6049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN CONROY
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Credential | DO
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Telephone | 817-320-9956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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