Provider Demographics
NPI:1689819948
Name:MONTANE, NELSON (MA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MONTANE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W COLUMBUS DR
Mailing Address - Street 2:STE 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1869
Mailing Address - Country:US
Mailing Address - Phone:813-341-5100
Mailing Address - Fax:813-341-5101
Practice Address - Street 1:3401 W COLUMBUS DR
Practice Address - Street 2:STE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1869
Practice Address - Country:US
Practice Address - Phone:813-341-5100
Practice Address - Fax:813-341-5101
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 43149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA43149OtherMASSAGE THERAPIST