Provider Demographics
NPI:1801214960
Name:MONTECILLO, RHEA (PT)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:MONTECILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 STONEBROOK PL
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3652
Mailing Address - Country:US
Mailing Address - Phone:731-664-7060
Mailing Address - Fax:731-664-5005
Practice Address - Street 1:85 STONEBROOK PL
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3652
Practice Address - Country:US
Practice Address - Phone:731-664-7060
Practice Address - Fax:731-664-5005
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist