Provider Demographics
NPI:1700629557
Name:MOMENT PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:MOMENT PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATA-CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-664-1649
Mailing Address - Street 1:3040 21ST ST PH 6
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4453
Mailing Address - Country:US
Mailing Address - Phone:734-664-1649
Mailing Address - Fax:
Practice Address - Street 1:2 W 45TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4269
Practice Address - Country:US
Practice Address - Phone:734-664-1649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy