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NPI Code Detail

MEDICARE: DESIRAE NICOLE MONTGOMERY PT, DPT

MEDICARE: DESIRAE NICOLE MONTGOMERY PT, DPT
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 Therapist1336198TX

General Provider Information

NPI Number : 1801761242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIRAE NICOLE MONTGOMERY PT, DPT
Provider Business Mailing Address
First Line : 3946 CALGARY CIR
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-1552
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11200 WESTHEIMER RD STE 235
Second Line :
City : HOUSTON
State : TX
Zip : 77042-3226
Country : US
Telephone Number : 713-781-1401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2025
Last Update Date : 10/07/2025

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