Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5368 | AZ |
N | 2251E1200X | Ergonomics | 5368 | AZ |
N | 225XE1200X | Ergonomics | 5368 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 5368 | AZ |
N | 2251N0400X | Physical Therapist - Neurology | 5368 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 5368 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 5368 | AZ |
NPI | 1447438890 |
---|---|
Provider Name | Mr. Stephen Lyle Montierth |
First Address | Mesa, AZ 85206-2239 |
Second Address | Mesa, AZ 85206-2239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 07/02/2008 |