Provider Demographics
NPI:1376230680
Name:MONTOYA, KRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 E FORT UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2850
Mailing Address - Country:US
Mailing Address - Phone:801-997-8881
Mailing Address - Fax:801-944-5910
Practice Address - Street 1:1787 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2850
Practice Address - Country:US
Practice Address - Phone:801-997-8881
Practice Address - Fax:801-944-5910
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7682510-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist