Provider Demographics
NPI:1497186464
Name:ANDERSON, MONTANA MARIE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MONTANA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:3450 COBB PKWY NW
Practice Address - Street 2:STE 220
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8351
Practice Address - Country:US
Practice Address - Phone:770-974-1978
Practice Address - Fax:770-974-1979
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08695225100000X
GAPT011516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist