Provider Demographics
NPI:1699748376
Name:MONTAGUE, SYLVIA A (PT)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:A
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NEW SOUTH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4073
Mailing Address - Country:US
Mailing Address - Phone:413-582-0005
Mailing Address - Fax:413-582-7979
Practice Address - Street 1:17 NEW SOUTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4073
Practice Address - Country:US
Practice Address - Phone:413-582-0005
Practice Address - Fax:413-582-7979
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20785225100000X
WAPT00003667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341810Medicaid
WA8341810Medicaid