Provider Demographics
NPI:1558429597
Name:MONTGOMERY, LORI DEBORAH (DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DEBORAH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DEBORAH
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1206 N STONEMAN AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1000
Mailing Address - Country:US
Mailing Address - Phone:626-590-9429
Mailing Address - Fax:
Practice Address - Street 1:18425 BURBANK BLVD STE 413
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6677
Practice Address - Country:US
Practice Address - Phone:818-996-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29546AMedicare ID - Type UnspecifiedPHYSICAL THERAPY