Provider Demographics
NPI:1457376824
Name:MONTGOMERY, BRADLEY SCOTT (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UWA STATION 14
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-0682
Mailing Address - Country:US
Mailing Address - Phone:205-652-3696
Mailing Address - Fax:205-652-3799
Practice Address - Street 1:UWA STATION 14
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-0682
Practice Address - Country:US
Practice Address - Phone:205-652-3696
Practice Address - Fax:205-652-3799
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL068390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program