Provider Demographics
NPI:1316785413
Name:MONTGOMERY, SASHA RONNAY (LMT)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:RONNAY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2208
Mailing Address - Country:US
Mailing Address - Phone:475-330-0695
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2883
Practice Address - Country:US
Practice Address - Phone:800-721-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist