Individual
MICHAEL WAYNE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC, LAT, LMT
Contact information
Practice address
102 CRYSTAL SPRINGS DR, BARDSTOWN, KY 40004-8203
(502) 460-4557
Mailing address
102 CRYSTAL SPRINGS DR, BARDSTOWN, KY 40004-8203
(502) 460-4557
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36000895A
IN
225700000X
Massage Therapist
Primary
106160
KY
Other
Enumeration date
03/16/2006
Last updated
12/30/2024
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