Provider Demographics
NPI:1447886320
Name:MOMENTUM REHAB & THERAPY
Entity type:Organization
Organization Name:MOMENTUM REHAB & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STABLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-375-7345
Mailing Address - Street 1:5349 SNAPFINGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4028
Mailing Address - Country:US
Mailing Address - Phone:470-375-7345
Mailing Address - Fax:470-200-2768
Practice Address - Street 1:5349 SNAPFINGER WOODS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4028
Practice Address - Country:US
Practice Address - Phone:470-375-7345
Practice Address - Fax:470-200-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center