Healthcare Provider Details

I. General information

NPI: 1457376824
Provider Name (Legal Business Name): BRADLEY SCOTT MONTGOMERY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UWA STATION 14
LIVINGSTON AL
35470-0682
US

IV. Provider business mailing address

UWA STATION 14
LIVINGSTON AL
35470-0682
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-3696
  • Fax: 205-652-3799
Mailing address:
  • Phone: 205-652-3696
  • Fax: 205-652-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number068
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: