Provider Demographics
NPI:1366297541
Name:MONTGOMERY, MADISON MICHELLE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MICHELLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15822 LOWER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4613
Mailing Address - Country:US
Mailing Address - Phone:713-492-1274
Mailing Address - Fax:
Practice Address - Street 1:15822 LOWER LAKE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4613
Practice Address - Country:US
Practice Address - Phone:713-492-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program