Provider Demographics
NPI:1770800799
Name:MONTGOMERY, LINDSEY R (LMP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:R
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3771
Mailing Address - Country:US
Mailing Address - Phone:206-937-3965
Mailing Address - Fax:206-937-4695
Practice Address - Street 1:3703 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3771
Practice Address - Country:US
Practice Address - Phone:206-937-3965
Practice Address - Fax:206-937-4695
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60116935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist