Healthcare Provider Details

I. General information

NPI: 1073448734
Provider Name (Legal Business Name): CONNIE L MONTES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3463 LAWRENCEVILLE SUWANEE RD STE 116
SUWANEE GA
30024-6543
US

IV. Provider business mailing address

382 EMILY DR SW
LILBURN GA
30047-5223
US

V. Phone/Fax

Practice location:
  • Phone: 770-666-1498
  • Fax:
Mailing address:
  • Phone: 770-666-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: