Organization
MOMENTUM PT & WELLNESS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER WHITESIDE DPT (PRESIDENT)
(703) 980-5570
Entity
Organization
Contact information
Practice address
2467 S 17TH ST UNIT A, WILMINGTON, NC 28401-7903
(910) 769-1238
(910) 777-5691
Mailing address
2467 S 17TH ST UNIT A, WILMINGTON, NC 28401-7903
(910) 769-1238
(910) 777-5691
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
11905
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069KY
BCBS OF NC
NC
01
—
2506019
MEDICARE PTAN
NC
Enumeration date
09/15/2013
Last updated
08/13/2025
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