Provider Demographics
NPI:1114028305
Name:MONTANA, JAMES VINCENT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:VINCENT
Last Name:MONTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-529-5777
Mailing Address - Fax:530-529-5772
Practice Address - Street 1:100 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3954
Practice Address - Country:US
Practice Address - Phone:530-241-1473
Practice Address - Fax:530-529-5772
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ135352OtherBLUE SHIELD GROUP NUMBER
CAP00052571OtherRAIL ROAD MEDICARE PIN
CAPT0146850Medicaid
CAZZZ26923ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CA0PT146850Medicare PIN