Provider Demographics
NPI:1154852325
Name:MONTGOMERY, CHRISTYNA NOELLE (LCM)
Entity Type:Individual
Prefix:
First Name:CHRISTYNA
Middle Name:NOELLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 FRANKLIN DR,
Mailing Address - Street 2:APT. 802
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:214-335-9855
Mailing Address - Fax:
Practice Address - Street 1:2827 MARKET CENTER DR
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6565
Practice Address - Country:US
Practice Address - Phone:214-335-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist