Provider Demographics
NPI:1982051520
Name:MONTGOMERY, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 30TH ST NE
Mailing Address - Street 2:APT D
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-2467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 30TH ST NE
Practice Address - Street 2:APT D
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2467
Practice Address - Country:US
Practice Address - Phone:541-417-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60651692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist