Provider Demographics
NPI:1851679971
Name:MONTES, JACQUELINE (PT, EDD, NCS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:MONTES
Suffix:
Gender:F
Credentials:PT, EDD, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:ROOM 517
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-342-5767
Mailing Address - Fax:212-305-9263
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:ROOM 517
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-342-5767
Practice Address - Fax:212-305-9263
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014490-12251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology