Provider Demographics
NPI:1821721218
Name:MONTOYA, JOHN DOMNIC TUAZON
Entity Type:Individual
Prefix:
First Name:JOHN DOMNIC
Middle Name:TUAZON
Last Name:MONTOYA
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 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:310 N ED CAREY DR STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7985
Practice Address - Country:US
Practice Address - Phone:956-687-4559
Practice Address - Fax:956-618-1342
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist