Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A03218 | KY |
NPI | 1003225913 |
---|---|
Provider Name | Brett Montgomery |
First Address | Shelbyville, KY 40065-8807 |
Second Address | Louisville, KY 40222-5185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2014 |
Last Update Date | 05/08/2014 |