Provider Demographics
NPI:1285104794
Name:MONTGOMERY, ALEXIS (MED, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ATHLETIC ST
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-9134
Mailing Address - Country:US
Mailing Address - Phone:843-409-9780
Mailing Address - Fax:828-689-1313
Practice Address - Street 1:100 ATHLETIC ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9134
Practice Address - Country:US
Practice Address - Phone:828-689-1190
Practice Address - Fax:828-689-1313
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-28232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer