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General NPI Number Information
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NPI Number | 1164082509
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Entity Type | Individual
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Provider Name | JOSEPH LOUIS MONTOYA PTA
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 777 BANNOCK ST # MC8102
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City | DENVER
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State | CO
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Zip | 80204-4507
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Country | US
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Telephone | 303-602-7419
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Fax | 303-602-7311
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Provider Business Mailing Address
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Address Line | 1346 S NEWPORT ST
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City | DENVER
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State | CO
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Zip | 80224-2016
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Country | US
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Telephone | 303-596-5505
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.0012788
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License Number State | CO
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