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General NPI Number Information
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NPI Number | 1972027654
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Entity Type | Organization
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Legal Business Name | MOMENTUM PHYSICAL THERAPY AND FITNESS PLLC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 14540 7TH ST
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City | DADE CITY
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State | FL
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Zip | 33523-3101
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Country | US
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Telephone | 813-838-3079
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Fax |
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Provider Business Mailing Address
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Address Line | 14540 7TH ST
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City | DADE CITY
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State | FL
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Zip | 33523-3101
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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 | MANAGER
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Name | CRAIG S VECCHIARELLI
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Credential | PT
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Telephone | 813-838-3079
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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 |
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License Number State |
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