Healthcare Provider Details

I. General information

NPI: 1730038340
Provider Name (Legal Business Name): MADISON ALYSSA MONTANO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S PARK ST
DEER PARK WA
99006-7025
US

IV. Provider business mailing address

501 N ARCADIA AVE
DEER PARK WA
99006-5663
US

V. Phone/Fax

Practice location:
  • Phone: 509-276-8811
  • Fax: 866-629-4801
Mailing address:
  • Phone: 509-276-8811
  • Fax: 866-629-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.P1.70125948
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: