Provider Demographics
NPI:1568604148
Name:BACKUS, MONTY (PT)
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:
Last Name:BACKUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2227
Mailing Address - Country:US
Mailing Address - Phone:513-985-3700
Mailing Address - Fax:513-985-3706
Practice Address - Street 1:8311 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2227
Practice Address - Country:US
Practice Address - Phone:513-985-3700
Practice Address - Fax:513-985-3706
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist