MEDICARE: LANDON TOLBERT MONTGOMERY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1156989	TX

General Provider Information

NPI Number	:	1053389312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDON TOLBERT MONTGOMERY PT

Provider Business Mailing Address
First Line	:	3001 HIGHWAY 121
Second Line	:	UNIT 292
City	:	EULESS
State	:	TX
Zip	:	76039
Country	:	US
Telephone Number	:	817-684-0397
Fax Number	:	817-684-0397

Provider Business Practice Location Address
First Line	:	3001 HIGHWAY 121
Second Line	:	UNIT 292
City	:	EULESS
State	:	TX
Zip	:	76039
Country	:	US
Telephone Number	:	817-684-0397
Fax Number	:	817-684-0397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	12/11/2008

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