Provider Demographics
NPI:1225801681
Name:MONTOYA, RICARDO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:MONTOYA
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 1:1230 AVINA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927-5558
Mailing Address - Country:US
Mailing Address - Phone:831-320-4305
Mailing Address - Fax:
Practice Address - Street 1:1230 AVINA AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-5558
Practice Address - Country:US
Practice Address - Phone:831-320-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist