Provider Demographics
NPI:1558595819
Name:MONTZ, JEREMY C (DPT, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:C
Last Name:MONTZ
Suffix:
Gender:M
Credentials:DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S VILLA SAN MARCO DR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4165
Mailing Address - Country:US
Mailing Address - Phone:985-855-2153
Mailing Address - Fax:
Practice Address - Street 1:1217 DUNN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-751-2000
Practice Address - Fax:904-751-2500
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24676225100000X
LAATH.2000122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer