Provider Demographics
NPI:1053389312
Name:MONTGOMERY, LANDON TOLBERT (PT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:TOLBERT
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HIGHWAY 121
Mailing Address - Street 2:UNIT 292
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:817-684-0397
Mailing Address - Fax:817-684-0397
Practice Address - Street 1:3001 HIGHWAY 121
Practice Address - Street 2:UNIT 292
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:817-684-0397
Practice Address - Fax:817-684-0397
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist