Provider Demographics
NPI:1952730327
Name:MONTOYA, KELLY (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8311 BRIMHALL RD STE 1904
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4367
Mailing Address - Country:US
Mailing Address - Phone:661-679-6238
Mailing Address - Fax:661-679-6243
Practice Address - Street 1:8311 BRIMHALL RD STE 1904
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-4367
Practice Address - Country:US
Practice Address - Phone:661-679-6238
Practice Address - Fax:661-679-6243
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist