Provider Demographics
NPI:1235476615
Name:MONTGOMERY, TERESA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:NICOLE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3053 BRYAN CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3344
Mailing Address - Country:US
Mailing Address - Phone:530-306-5156
Mailing Address - Fax:
Practice Address - Street 1:3084 CEDAR RAVINE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5617
Practice Address - Country:US
Practice Address - Phone:530-621-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist