Provider Demographics
NPI:1114991619
Name:MONTROSS, WILLIAM A (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:MONTROSS
Suffix:
Gender:M
Credentials:PT
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 1902
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0902
Mailing Address - Country:US
Mailing Address - Phone:570-714-6460
Mailing Address - Fax:570-714-6461
Practice Address - Street 1:520 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5803
Practice Address - Country:US
Practice Address - Phone:570-714-6460
Practice Address - Fax:570-714-6461
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008951L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001944500Medicaid
PA067319N62Medicare PIN
PA001944500Medicaid
PA067319Medicare ID - Type Unspecified