Healthcare Provider Details

I. General information

NPI: 1487816534
Provider Name (Legal Business Name): RYAN J MONTGOMERY MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 GREENUP AVE
ASHLAND KY
41101-1953
US

IV. Provider business mailing address

2700 GREENUP AVE
ASHLAND KY
41101-1953
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0540
  • Fax: 606-324-0616
Mailing address:
  • Phone: 606-324-0540
  • Fax: 606-324-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2701
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005341
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: