Provider Demographics
NPI:1740431923
Name:MONTGOMERY, MARGI ELIZABETH (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MARGI
Middle Name:ELIZABETH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 32ND AVE NW
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6308
Mailing Address - Country:US
Mailing Address - Phone:360-621-4136
Mailing Address - Fax:
Practice Address - Street 1:5401 32ND AVE NW
Practice Address - Street 2:SUITE 106
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6308
Practice Address - Country:US
Practice Address - Phone:360-621-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0334139OtherL&I