Provider Demographics
NPI:1053703165
Name:HO, MONTANA VAN (DPT, DOM)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:VAN
Last Name:HO
Suffix:
Gender:M
Credentials:DPT, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WHEELHOUSE LN STE 1451
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3696
Mailing Address - Country:US
Mailing Address - Phone:407-878-0507
Mailing Address - Fax:844-904-0880
Practice Address - Street 1:245 WHEELHOUSE LN STE 1451
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3696
Practice Address - Country:US
Practice Address - Phone:407-878-0507
Practice Address - Fax:844-904-0880
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3608171100000X
FLPT29612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP3608OtherSTATE LICENSE
FLPT29612OtherSTATE LICENSE