Provider Demographics
NPI:1053199554
Name:MONTILLA, MORRIS SAMUEL RIBAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:MORRIS SAMUEL
Middle Name:RIBAS
Last Name:MONTILLA
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 1:27 GERANIUM AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3012
Mailing Address - Country:US
Mailing Address - Phone:707-716-7118
Mailing Address - Fax:
Practice Address - Street 1:295 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6434
Practice Address - Country:US
Practice Address - Phone:121-268-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist