MEDICARE: ANGELA MONTGOMERY CPO

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1891394797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MONTGOMERY CPO

Provider Business Mailing Address
First Line	:	2290 E PROSPECT RD STE 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9768
Country	:	US
Telephone Number	:	970-462-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 E PROSPECT RD STE 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9768
Country	:	US
Telephone Number	:	970-462-9249
Fax Number	:

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

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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