Provider Demographics
NPI:1083058341
Name:MONTGOMERY, DONALD REX (PT,DPT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:REX
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 NE ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2910
Mailing Address - Country:US
Mailing Address - Phone:503-284-5811
Mailing Address - Fax:
Practice Address - Street 1:25030 SW PARKWAY AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-582-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01767261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy