Provider Demographics
NPI:1982900338
Name:MONTALVO, NIKKI COLLEEN (LMT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:COLLEEN
Last Name:MONTALVO
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 1:2019 ENCINO WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2429
Mailing Address - Country:US
Mailing Address - Phone:512-909-4449
Mailing Address - Fax:
Practice Address - Street 1:2601 E. SONTERRA BLVD
Practice Address - Street 2:SUITE 111, UNIT 57
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259
Practice Address - Country:US
Practice Address - Phone:512-909-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108906174400000X
TXMT131622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist