Provider Demographics
NPI:1316429285
Name:MONTANO, MICHELLE KIMBERLY
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KIMBERLY
Last Name:MONTANO
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 1:1104 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2479
Mailing Address - Country:US
Mailing Address - Phone:956-270-1525
Mailing Address - Fax:
Practice Address - Street 1:4800 W EXPY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3015
Practice Address - Country:US
Practice Address - Phone:956-682-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2113975225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant