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General NPI Number Information
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NPI Number | 1649423849
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Entity Type | Individual
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Provider Name | BRANDIS K MONTGOMERY PT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 611 HIGHWAY 74 S STE 720
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3081
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Country | US
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Telephone | 770-632-6800
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Fax | 770-632-6060
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Provider Business Mailing Address
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Address Line | 3455 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-9138
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Country | US
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Telephone | 770-554-0665
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Fax | 770-554-0685
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 005353
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License Number State | KY
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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 | 009891
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License Number State | GA
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