Provider Demographics
NPI:1427202803
Name:MONTGOMERY EAST PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MONTGOMERY EAST PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:3345-244-5892
Mailing Address - Street 1:499 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7105
Mailing Address - Country:US
Mailing Address - Phone:334-244-5892
Mailing Address - Fax:334-244-5890
Practice Address - Street 1:499 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7105
Practice Address - Country:US
Practice Address - Phone:334-244-5892
Practice Address - Fax:334-244-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700534Medicare PIN