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General NPI Number Information
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NPI Number | 1053703165
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Entity Type | Individual
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Provider Name | MONTANA VAN HO DPT, DOM
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Gender | Male
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 245 WHEELHOUSE LN STE 1451
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City | LAKE MARY
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State | FL
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Zip | 32746-3696
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Country | US
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Telephone | 407-878-0507
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Fax | 844-904-0880
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Provider Business Mailing Address
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Address Line | 245 WHEELHOUSE LN STE 1451
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City | LAKE MARY
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State | FL
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Zip | 32746-3696
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Country | US
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Telephone | 407-878-0507
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Fax | 844-904-0880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3608
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT29612
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License Number State | FL
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