1497010128 NPI number — MOMENTUM PHYSICAL THERAPY AND FITNESS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497010128 NPI number — MOMENTUM PHYSICAL THERAPY AND FITNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOMENTUM PHYSICAL THERAPY AND FITNESS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497010128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2219 NORTHGLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-351-8436
Provider Business Mailing Address Fax Number:
719-465-1043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2219 NORTHGLEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-351-8436
Provider Business Practice Location Address Fax Number:
719-465-1043
Provider Enumeration Date:
07/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BATCHELDER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-351-8436

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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