Healthcare Provider Details

I. General information

NPI: 1275517500
Provider Name (Legal Business Name): THOMAS PAUL MONTGOMERY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W MAIN ST
CORTLAND OH
44410-1432
US

IV. Provider business mailing address

148 W MAIN ST
CORTLAND OH
44410-1432
US

V. Phone/Fax

Practice location:
  • Phone: 330-638-7310
  • Fax: 330-638-7257
Mailing address:
  • Phone: 330-638-7310
  • Fax: 330-638-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: