MEDICARE: MOMENTUM PHYSICAL THERAPY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT21553	FL

General Provider Information

NPI Number	:	1548691652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM PHYSICAL THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	4113 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:	954-332-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4113 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:	954-332-0501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WENDY YUNKER
Credential	:	PT
Telephone Number	:	954-332-0501

Provider Enumeration Date	:	11/29/2013
Last Update Date	:	01/25/2014

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