Provider Demographics
NPI:1407881642
Name:MONTENERY, JASON P (PT)
Entity Type:Individual
Prefix:MISS
First Name:JASON
Middle Name:P
Last Name:MONTENERY
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 1:2586 HIGHWAY 17 SOUTH
Mailing Address - Street 2:UNIT C & D
Mailing Address - City:GARDEN CITY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6605
Mailing Address - Country:US
Mailing Address - Phone:843-651-6565
Mailing Address - Fax:843-651-6575
Practice Address - Street 1:2586 HIGHWAY 17 BUSINESS SOUTH
Practice Address - Street 2:UNIT C & D
Practice Address - City:GARDEN CITY BEACH
Practice Address - State:SC
Practice Address - Zip Code:29576-6605
Practice Address - Country:US
Practice Address - Phone:843-651-6565
Practice Address - Fax:843-651-6575
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ331698078Medicare PIN