Provider Demographics
NPI:1538216114
Name:MONTGOMERY, SHEILA ANNETTE (LMT)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANNETTE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 SW 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3744
Mailing Address - Country:US
Mailing Address - Phone:503-754-9008
Mailing Address - Fax:
Practice Address - Street 1:5035 SW 141ST AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3744
Practice Address - Country:US
Practice Address - Phone:503-754-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5356172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist