Provider Demographics
NPI:1013421601
Name:MONTANA, BAILEY ELIZABETH BANKS (DPT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ELIZABETH BANKS
Last Name:MONTANA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15404 MERRY CAT LANE
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306
Mailing Address - Country:US
Mailing Address - Phone:757-302-6140
Mailing Address - Fax:757-302-6141
Practice Address - Street 1:15405 MERRY CAT LANE
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-302-6140
Practice Address - Fax:757-302-6141
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist