Provider Demographics
NPI:1932415791
Name:MONTES, ANTONIO MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MICHAEL
Last Name:MONTES
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 1:804 CRANDALL HALL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-1489
Mailing Address - Country:US
Mailing Address - Phone:843-536-0574
Mailing Address - Fax:843-536-0578
Practice Address - Street 1:804 CRANDALL HALL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-1489
Practice Address - Country:US
Practice Address - Phone:843-536-3574
Practice Address - Fax:843-536-0578
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist