Provider Demographics
NPI:1457016180
Name:TAD MONTGOMERY, INC.
Entity Type:Organization
Organization Name:TAD MONTGOMERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:940-393-2620
Mailing Address - Street 1:1121 COUNTY ROAD 2224
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6658
Mailing Address - Country:US
Mailing Address - Phone:940-255-2255
Mailing Address - Fax:
Practice Address - Street 1:1121 COUNTY ROAD 2224
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-6658
Practice Address - Country:US
Practice Address - Phone:940-255-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty