Provider Demographics
NPI:1205934049
Name:MONTGOMERY, FORREST GRANT (PT PHYSICAL THERAPIS)
Entity type:Individual
Prefix:MR
First Name:FORREST
Middle Name:GRANT
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DOGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019
Mailing Address - Country:US
Mailing Address - Phone:501-909-1560
Mailing Address - Fax:501-257-6419
Practice Address - Street 1:4300 WEST 7TH ST
Practice Address - Street 2:LITTLE ROCK VA
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-6408
Practice Address - Fax:501-257-6419
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist