Healthcare Provider Details

I. General information

NPI: 1003136284
Provider Name (Legal Business Name): RENEE LYNN MONTI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8660
  • Fax:
Mailing address:
  • Phone: 608-775-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number416-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: