Provider Demographics
NPI:1316667405
Name:MONTGOMERY, MARIE DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DENISE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:8412 CEDARBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1002
Mailing Address - Country:US
Mailing Address - Phone:215-668-8984
Mailing Address - Fax:267-335-4078
Practice Address - Street 1:8412 CEDARBROOK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1002
Practice Address - Country:US
Practice Address - Phone:215-668-8984
Practice Address - Fax:267-335-4078
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAYM006122L227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered