Healthcare Provider Details

I. General information

NPI: 1245168285
Provider Name (Legal Business Name): ISAAC MONTAGUE DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GATEWAY BLVD UNIT 2
ROCK SPRINGS WY
82901-6727
US

IV. Provider business mailing address

2002 W SUNSET DR STE 1
RIVERTON WY
82501-2285
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-3626
  • Fax: 307-352-3628
Mailing address:
  • Phone: 307-352-3626
  • Fax: 307-352-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2613
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: