Provider Demographics
NPI:1033405964
Name:MONTON, MARK FHIL QUINTANA (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK FHIL
Middle Name:QUINTANA
Last Name:MONTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6919 PITTSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2727
Mailing Address - Country:US
Mailing Address - Phone:734-709-0187
Mailing Address - Fax:
Practice Address - Street 1:14555 LEVAN RD STE 215
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5085
Practice Address - Country:US
Practice Address - Phone:734-542-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist