Organization
MOMENTUM REHABILITATION SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY L BRACISZEWSKI PHD (DIRECTOR)
(734) 320-2497
Entity
Organization
Contact information
Practice address
7926 ANN ARBOR ST, DEXTER, MI 48130-1344
(734) 320-2497
(810) 231-0771
Mailing address
8838 HENDRICKS DR, BRIGHTON, MI 48116-9111
(734) 320-2497
(810) 231-0771
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301006431
MI
103T00000X
Psychologist
6301006431
MI
103TB0200X
Cognitive & Behavioral Psychologist
6301006431
MI
103TC0700X
Clinical Psychologist
6301006431
MI
103TH0100X
Health Service Psychologist
6301006431
MI
103TP2701X
Group Psychotherapy Psychologist
6301006431
MI
103TR0400X
Rehabilitation Psychologist
6301006431
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610093200
OWCS ACS
OH
01
—
680H146930
BCBSM
MI
01
—
OD74512
TRUST
—
Enumeration date
04/24/2007
Last updated
04/25/2014
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