Provider Demographics
NPI:1245919257
Name:MONTALTO, NOAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:MONTALTO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 KNOLL WICK RD APT 203
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2054
Mailing Address - Country:US
Mailing Address - Phone:224-400-1372
Mailing Address - Fax:
Practice Address - Street 1:750 PASQUINELLI DR STE 204
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1291
Practice Address - Country:US
Practice Address - Phone:630-560-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty