Provider Demographics
NPI:1235418112
Name:MONTGOMERY, ADRIANE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ADRIANE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19203 WILDOATS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3993
Mailing Address - Country:US
Mailing Address - Phone:281-682-9031
Mailing Address - Fax:713-621-2491
Practice Address - Street 1:3000 RICHMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3188
Practice Address - Country:US
Practice Address - Phone:713-621-2486
Practice Address - Fax:713-621-2491
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2033520225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant