Provider Demographics
NPI:1033275573
Name:MONTGOMERY, KEVIN L (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 PINKERTON RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8678
Mailing Address - Country:US
Mailing Address - Phone:724-816-9184
Mailing Address - Fax:
Practice Address - Street 1:1114 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-3333
Practice Address - Country:US
Practice Address - Phone:352-394-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019108225100000X
FL22809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist