Provider Demographics
NPI:1821483413
Name:MONTGOMERY, MITCHELL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 ROCK CHALK DR STE 1700
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5232
Mailing Address - Country:US
Mailing Address - Phone:785-838-7885
Mailing Address - Fax:785-505-5311
Practice Address - Street 1:6265 ROCK CHALK DR STE 1700
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-838-7885
Practice Address - Fax:785-505-5311
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist