Provider Demographics
NPI:1174826879
Name:MONTGOMERY, RONDA JANE (LMT)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:JANE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:JANE
Other - Last Name:DE BOER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2130 ALEMANDA DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 ALEMANDA DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3709
Practice Address - Country:US
Practice Address - Phone:727-204-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist