Provider Demographics
NPI:1538507728
Name:MONTEJO, MIRANDA CHRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CHRISTINA
Last Name:MONTEJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S COLONY WAY
Mailing Address - Street 2:SUITE 3 PMB 226
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6900
Mailing Address - Country:US
Mailing Address - Phone:951-531-7515
Mailing Address - Fax:
Practice Address - Street 1:1150 S COLONY WAY
Practice Address - Street 2:SUITE 3 PMB 226
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6900
Practice Address - Country:US
Practice Address - Phone:951-531-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist