Provider Demographics
NPI:1265693089
Name:MONTGOMERY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:MONTGOMERY PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-593-5813
Mailing Address - Street 1:5900 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1419
Mailing Address - Country:US
Mailing Address - Phone:240-593-5813
Mailing Address - Fax:240-235-4212
Practice Address - Street 1:5900 GRANBY RD
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1419
Practice Address - Country:US
Practice Address - Phone:240-593-5813
Practice Address - Fax:240-235-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty