Healthcare Provider Details

I. General information

NPI: 1831403096
Provider Name (Legal Business Name): SANDRA ANN MONTIE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CONGRESS ST
OCONTO WI
54153-1503
US

IV. Provider business mailing address

309 CONGRESS ST
OCONTO WI
54153-1503
US

V. Phone/Fax

Practice location:
  • Phone: 920-609-0647
  • Fax:
Mailing address:
  • Phone: 920-609-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1493-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: