Provider Demographics
NPI:1215248786
Name:MONTGOMERY, VICTORIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 N DRINKWATER BLVD
Mailing Address - Street 2:APARTMENT E203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3647
Mailing Address - Country:US
Mailing Address - Phone:317-446-8318
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3200
Practice Address - Country:US
Practice Address - Phone:480-980-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist