Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8951 | SC |
NPI | 1003316977 |
---|---|
Provider Name | Lauren Elizabeth Montgomery |
First Address | Lexington, SC 29071-1590 |
Second Address | Lexington, SC 29073-7942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2018 |
Last Update Date | 17/02/2018 |