Provider Demographics
NPI:1760186605
Name:MONTGOMERY, SARA ALLISON (BCTMB, LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ALLISON
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 FOREST RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4688
Mailing Address - Country:US
Mailing Address - Phone:434-385-0161
Mailing Address - Fax:
Practice Address - Street 1:18250 FOREST RD STE 3
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4688
Practice Address - Country:US
Practice Address - Phone:434-385-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist