Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2782 | NE |
NPI | 1023470630 |
---|---|
Provider Name | Christine Montes |
First Address | Fremont, NE 68025-2303 |
Second Address | Fremont, NE 68025-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/03/2016 |