Provider Demographics
NPI:1992404669
Name:MONTALVO, DOUGLAS WILLIAM (DPT)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3922 WISEMAN BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1600
Mailing Address - Country:US
Mailing Address - Phone:210-775-6655
Mailing Address - Fax:210-761-7291
Practice Address - Street 1:3922 WISEMAN BLVD STE 502
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1600
Practice Address - Country:US
Practice Address - Phone:210-775-6655
Practice Address - Fax:210-761-7291
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1373274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist