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General NPI Number Information
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NPI Number | 1508313016
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Entity Type | Individual
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Provider Name | AUSTIN MONTGOMERY ATC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 761 BUFFALO FORD DR
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City | CLARKSVILLE
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State | TN
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Zip | 37042-2770
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Country | US
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Telephone | 812-319-2814
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Fax |
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Provider Business Mailing Address
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Address Line | 7940 DESTINY BLVD
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City | DPO
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State | AA
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Zip | 42223
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | KY
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