Individual
MARK MONTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1058
OH
225200000X
Physical Therapy Assistant
Primary
A4994
NC
Other
Enumeration date
04/04/2007
Last updated
02/14/2013
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