Provider Demographics
NPI:1912095035
Name:MONTGOMERY, TARA N (MSPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:N
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:9088 RIDGELINE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2380
Practice Address - Country:US
Practice Address - Phone:720-458-0525
Practice Address - Fax:720-536-5365
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51276542Medicaid
CO51276542Medicaid
COQ32572Medicare UPIN