The Mog LLC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT433 Issued in ME

Legal business name

THE MOG LLC

Doing business as

Momentum Performance
United Medical Gym

Practice address

125 John Roberts Rd Ste 16
South Portland, ME 04106-6983

Phone

(207) 347-3030

Fax

(207) 536-4449

NPI assigned

Jan 3, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christopher S Pribish, ATC, CSCS, CSAC

Title

Owner

Phone

(207) 347-3030

Specialties & licenses 3

Addresses

Other names 2

• Momentum Performance Doing business as
• United Medical Gym Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adam T Hanrahan

  • Athletic Trainer
  • South Portland, ME
  • NPI 1841707551
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1295242923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 JOHN ROBERTS RD STE 16",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066983",
            "telephone_number": "207-347-3030",
            "fax_number": "207-536-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 JOHN ROBERTS RD STE 16",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066983",
            "telephone_number": "207-347-3030",
            "fax_number": "207-536-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MOG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "PRIBISH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-347-3030",
        "authorized_official_credential": "ATC, CSCS, CSAC"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT433",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT241",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT500",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Momentum Performance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "United Medical Gym",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kinna Thakarar, DO
• Rose Thatcher, MD
• Cliodhna Thayer
• Niole Thayer, RN
• The Lactation Network, LLC
• The Opportunity Alliance
• The Opportunity Alliance
• The Opportunity Alliance
• Peter Rene Then, DMD DR MED DENT
• Sonya L Theriault, LCSW

• Athletic Trainer in South Portland, ME
• Providers in South Portland, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.