Individual
GRACE MALLIS MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4707 W GANDY BLVD STE 3, TAMPA, FL 33611-3310
(813) 728-6601
Mailing address
12831 TIKAL WAY, TRINITY, FL 34655-7253
(727) 386-3896
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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