Provider Demographics
NPI:1376673913
Name:MONTAGNE, DENISE A (PT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:A
Last Name:MONTAGNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 NORTH HILLS BLVD. STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506
Mailing Address - Country:US
Mailing Address - Phone:775-323-4325
Mailing Address - Fax:775-323-4325
Practice Address - Street 1:1055 NORTH HILLS BLVD.
Practice Address - Street 2:STE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506
Practice Address - Country:US
Practice Address - Phone:775-323-4325
Practice Address - Fax:775-323-4325
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0614225100000X
NENV0614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416354Medicaid
32454Medicare UPIN
NV003416354Medicaid