Provider Demographics
NPI:1407299449
Name:MONTAGUE, DANIEL R (LMP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5409
Mailing Address - Country:US
Mailing Address - Phone:509-499-4171
Mailing Address - Fax:
Practice Address - Street 1:430 W 2ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-6003
Practice Address - Country:US
Practice Address - Phone:509-624-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60336323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist