Provider Demographics
NPI:1861618993
Name:MONTGOMERY, BHANU (PT)
Entity type:Individual
Prefix:MRS
First Name:BHANU
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 SILVER CREEK RD STE 133
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8361
Mailing Address - Country:US
Mailing Address - Phone:928-704-2194
Mailing Address - Fax:928-704-2195
Practice Address - Street 1:2767 SILVER CREEK RD
Practice Address - Street 2:SUITE B
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8227
Practice Address - Country:US
Practice Address - Phone:928-704-2194
Practice Address - Fax:928-704-2195
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist