Provider Demographics
NPI:1831821826
Name:MONTGOMERY, TREVOR KEITH (PT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:KEITH
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WOODED ACRE LOOP
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-4806
Mailing Address - Country:US
Mailing Address - Phone:254-479-6929
Mailing Address - Fax:
Practice Address - Street 1:724 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3514
Practice Address - Country:US
Practice Address - Phone:940-270-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic