Provider Demographics
NPI:1508991159
Name:MONTEITH, CHARLES R III (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:MONTEITH
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OAK DR
Mailing Address - Street 2:REID ATHLETIC CENTER
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1338
Mailing Address - Country:US
Mailing Address - Phone:315-228-6808
Mailing Address - Fax:
Practice Address - Street 1:13 OAK DR
Practice Address - Street 2:REID ATHLETIC CENTER
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1338
Practice Address - Country:US
Practice Address - Phone:315-228-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000984-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer