Provider Demographics
NPI:1518354497
Name:MONTAG, ALISON (ATC, ATR, ITAT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MONTAG
Suffix:
Gender:F
Credentials:ATC, ATR, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MINNESOTA AVE W
Mailing Address - Street 2:PO BOX 101
Mailing Address - City:MINNESOTA LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56068-3137
Mailing Address - Country:US
Mailing Address - Phone:712-209-2697
Mailing Address - Fax:
Practice Address - Street 1:11 MINNESOTA AVE W
Practice Address - Street 2:
Practice Address - City:MINNESOTA LAKE
Practice Address - State:MN
Practice Address - Zip Code:56068-3137
Practice Address - Country:US
Practice Address - Phone:712-209-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer