Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | P18274 | NC |
NPI | 1003462144 |
---|---|
Provider Name | James Montgomery |
First Address | Greenville, NC 27858-5238 |
Second Address | Tarboro, NC 27886-5055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |