Healthcare Provider Details

I. General information

NPI: 1629596903
Provider Name (Legal Business Name): CHRISTIAN MONTOYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CENTRAL AVE
LOS ALAMOS NM
87544-3244
US

IV. Provider business mailing address

24A FEATHER CATCHER
SANTA FE NM
87506-2698
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5043
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: