Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2018003455 | MO |
NPI | 1003315375 |
---|---|
Provider Name | Joshua Montague |
First Address | Chesterfield, MO 63017-5791 |
Second Address | Chesterfield, MO 63017-5791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |