Provider Demographics
NPI:1588700512
Name:MONTALI, PHYLLIS AMBROSE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:AMBROSE
Last Name:MONTALI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 TAMPA RD
Mailing Address - Street 2:BLDG. A, SUITE 200
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3670
Mailing Address - Country:US
Mailing Address - Phone:727-786-5482
Mailing Address - Fax:727-786-5595
Practice Address - Street 1:3850 TAMPA RD
Practice Address - Street 2:BLDG. A, SUITE 200
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3670
Practice Address - Country:US
Practice Address - Phone:727-786-5482
Practice Address - Fax:727-786-5595
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist