Healthcare Provider Details

I. General information

NPI: 1790692598
Provider Name (Legal Business Name): BRADEN MONTANEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4349 TALMADGE RD
TOLEDO OH
43623-3527
US

IV. Provider business mailing address

3363 SHADYWOOD DR
LAMBERTVILLE MI
48144-9620
US

V. Phone/Fax

Practice location:
  • Phone: 419-654-8818
  • Fax:
Mailing address:
  • Phone: 734-639-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: