Individual
REBECCA LYNNE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1722 E MARKS ST, ORLANDO, FL 32803-4242
(620) 340-5258
Mailing address
1722 E MARKS ST, ORLANDO, FL 32803-4242
(620) 340-5258
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
PT32273
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
880020100
—
FL
Enumeration date
02/22/2017
Last updated
03/06/2017
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