Provider Demographics
NPI:1548007685
Name:MOMOH, TYUS D (DPT)
Entity type:Individual
Prefix:
First Name:TYUS
Middle Name:D
Last Name:MOMOH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 CAMINATA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6757
Mailing Address - Country:US
Mailing Address - Phone:817-528-6280
Mailing Address - Fax:
Practice Address - Street 1:650 HIGHWAY 287 N STE 160
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6876
Practice Address - Country:US
Practice Address - Phone:817-375-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic