Provider Demographics
NPI:1700295235
Name:MONTALVO, AMANDA LEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1127
Mailing Address - Country:US
Mailing Address - Phone:973-248-8111
Mailing Address - Fax:
Practice Address - Street 1:49 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1127
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01574500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ373213PTEMedicare PIN