Provider Demographics
NPI:1437933215
Name:MONTGOMERY, SIERRA MCKENZIE (PT)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:MCKENZIE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:MCKENZIE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52493 RIVER PINE RD
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-8906
Mailing Address - Country:US
Mailing Address - Phone:971-241-5076
Mailing Address - Fax:
Practice Address - Street 1:51600 HUNTINGTON RD STE 103
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8887
Practice Address - Country:US
Practice Address - Phone:541-536-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist