Provider Demographics
NPI:1437430386
Name:ARAGON, MANUEL MONTANO (LMT)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:MONTANO
Last Name:ARAGON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NE HIGHWAY 20 STE 610-447
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6402
Mailing Address - Country:US
Mailing Address - Phone:949-375-7278
Mailing Address - Fax:
Practice Address - Street 1:568 NE SAVANNAH DR STE 5
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4866
Practice Address - Country:US
Practice Address - Phone:949-375-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-24958225700000X
CACAMTC 20733172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist