Provider Demographics
NPI:1326697343
Name:MONTAGUE, MICHAEL CHASE (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHASE
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SEVENTEENTH FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3503
Mailing Address - Country:US
Mailing Address - Phone:404-226-2402
Mailing Address - Fax:
Practice Address - Street 1:3405 DALLAS HWY SW STE 601
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6427
Practice Address - Country:US
Practice Address - Phone:770-438-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist