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General NPI Number Information
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NPI Number | 1811211998
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Entity Type | Organization
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Legal Business Name | MOMENTUM PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1512 PACHECO ST SUITE A-203
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City | SANTA FE
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State | NM
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Zip | 87505-5104
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Country | US
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Telephone | 505-473-2896
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Fax | 505-989-1468
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Provider Business Mailing Address
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Address Line | 1512 PACHECO ST SUITE A-203
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City | SANTA FE
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State | NM
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Zip | 87505-5104
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Country | US
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Telephone | 505-473-2896
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Fax | 505-989-1468
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | MS. CINDY L KIRBY
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Credential | M.S. P.T.
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Telephone | 505-473-2896
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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 | 2320
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License Number State | NM
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