Healthcare Provider Details

I. General information

NPI: 1437430386
Provider Name (Legal Business Name): MANUEL MONTANO ARAGON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 NE SAVANNAH DR STE 5
BEND OR
97701-4866
US

IV. Provider business mailing address

2660 NE HIGHWAY 20 STE 610-447
BEND OR
97701-6402
US

V. Phone/Fax

Practice location:
  • Phone: 949-375-7278
  • Fax:
Mailing address:
  • Phone: 949-375-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-24958
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberCAMTC 20733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: