NPIMap

Organization Active NPI

Momentum Physical Therapy

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1760547467
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24774 Issued in CA
Legal business name
MOMENTUM PHYSICAL THERAPY
Practice address
11500 W Olympic Blvd
Suite 350
Los Angeles, CA 90064-1524
Phone
(310) 721-2955
NPI assigned
Dec 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Tanya Lynn Dougherty, MPT
Title
President, Clinical Director
Phone
(310) 721-2955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 24774 CA Primary

Addresses

Primary practice location

11500 W Olympic Blvd
Suite 350
Los Angeles, CA 90064-1524

Mailing address

11500 W Olympic Blvd
Suite 350
Los Angeles, CA 90064-1524
Phone (310) 721-2955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070402000798 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284738162 Receives reassigned benefits from 8 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1000 Veteran Ave
Rm A381
Los Angeles, CA 90024
Phone (310) 721-2955

11500 W Olympic Blvd
Ste 350
Los Angeles, CA 90064
Phone (310) 473-8287

11500 W Olympic Blvd
Ste 470
Los Angeles, CA 90064
Phone (310) 473-8287

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1167004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760547467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641524",
            "telephone_number": "310-721-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641524",
            "telephone_number": "310-721-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT, CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "310-721-2955",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "24774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.