Provider Demographics
NPI:1760848337
Name:MONTGOMERY THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:MONTGOMERY THERAPY & WELLNESS LLC
Other - Org Name:THE AMPUTEE WALKING INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-417-2652
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:301-417-2652
Mailing Address - Fax:
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:301-417-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy