Individual
USBALDO MIGUEL MONTOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LATC
Contact information
Practice address
2051 E COMMERCIAL AVE, LOWELL, IN 46356-2115
(224) 656-7014
Mailing address
12800 MISSISSIPPI PKWY, CROWN POINT, IN 46307-6900
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002369A
IN
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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