Provider Demographics
NPI:1821081233
Name:MONTGOMERY THERAPY, LLC
Entity Type:Organization
Organization Name:MONTGOMERY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-417-2652
Mailing Address - Street 1:15245 SHADY GROVE RD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:301-417-2652
Mailing Address - Fax:301-417-2653
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE C100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-417-2652
Practice Address - Fax:301-417-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15462111261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD231747Medicare PIN