Provider Demographics
NPI:1962827188
Name:MONTGOMERY, MELISSA M (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:800 N STATE COLLEGE BLVD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3547
Mailing Address - Country:US
Mailing Address - Phone:657-278-7867
Mailing Address - Fax:
Practice Address - Street 1:800 N. STATE COLLEGE BLVD.
Practice Address - Street 2:DEPT. OF KINESIOLOGY
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:657-278-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer