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NPI Code Detail

MEDICARE: EMILY MONTGOMERY

MEDICARE: EMILY MONTGOMERY
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 Therapist1188701TX

General Provider Information

NPI Number : 1639462500
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY MONTGOMERY
Provider Business Mailing Address
First Line : 3007 FAREVIEW DR.
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-0442
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1112 GIBBINS RD.
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5618
Country : US
Telephone Number : 817-274-2584
Fax Number : 817-274-5390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 05/25/2011

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