Healthcare Provider Details

I. General information

NPI: 1366969685
Provider Name (Legal Business Name): LAUREN MARIE MONTFORT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 E HENRIETTA RD STE 500
ROCHESTER NY
14623-2655
US

IV. Provider business mailing address

18 FELLOWS RD
PENFIELD NY
14526-1908
US

V. Phone/Fax

Practice location:
  • Phone: 585-258-3811
  • Fax: 585-427-7410
Mailing address:
  • Phone: 585-200-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTL.0015101
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number046933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: