Provider Demographics
NPI:1013294313
Name:MONTGOMERY, CAROL ANN (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MONTGOMERY
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 1:2209 CANTERBURY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2275
Mailing Address - Country:US
Mailing Address - Phone:785-621-4570
Mailing Address - Fax:785-621-4571
Practice Address - Street 1:2209 CANTERBURY DR STE B
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2275
Practice Address - Country:US
Practice Address - Phone:785-621-4570
Practice Address - Fax:785-621-4571
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04335225100000X
IN05001916A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist