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NPI Code Detail

MEDICARE: LANDON TOLBERT MONTGOMERY PT

MEDICARE:   LANDON TOLBERT MONTGOMERY  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1156989TX

General Provider Information

NPI Number : 1053389312
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANDON TOLBERT MONTGOMERY PT
Provider Business Mailing Address
First Line : 3001 HIGHWAY 121
Second Line : UNIT 292
City : EULESS
State : TX
Zip : 76039
Country : US
Telephone Number : 817-684-0397
Fax Number : 817-684-0397
Provider Business Practice Location Address
First Line : 3001 HIGHWAY 121
Second Line : UNIT 292
City : EULESS
State : TX
Zip : 76039
Country : US
Telephone Number : 817-684-0397
Fax Number : 817-684-0397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 12/11/2008

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Directions to “ LANDON TOLBERT MONTGOMERY PT” Practice Location

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