Provider Demographics
NPI:1053791939
Name:MONTANO, MONIQUE JUSTINE (PTA)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:JUSTINE
Last Name:MONTANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S DOBSON RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6229
Mailing Address - Country:US
Mailing Address - Phone:480-703-2346
Mailing Address - Fax:
Practice Address - Street 1:235 S DOBSON RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6229
Practice Address - Country:US
Practice Address - Phone:480-306-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11512A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant