Basic Information
| Provider Information | |||||||||
| NPI: | 1053478982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | CAIN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 JOHNSTON ST SE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563409708 | ||||||||
| FaxNumber: | 2563409624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1228 S EUFAULA AVE | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360272718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343556009 | ||||||||
| FaxNumber: | 3343840522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 11/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT006569 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.