Individual
JUSTINE C MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
430 STONYCREEK ST, BOSWELL, PA 15531-1024
(814) 629-5612
(814) 629-7199
Mailing address
PO BOX 340, 136 S PINE AVE, STOYSTOWN, PA 15563-6002
(814) 893-5568
(814) 893-5989
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA053952
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031963260001
—
PA
Enumeration date
09/11/2009
Last updated
02/01/2018
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