Usbaldo Miguel Montoya, ATC, LATC
Individual provider Active NPI Athletic Trainer · Lowell, IN
NPI 1013394790 · NPPES record last updated Apr 30, 2015
Key facts
- NPI
- 1013394790
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 36002369A (IN)
- Practice address
- 2051 E Commercial Ave
Lowell, IN 46356-2115 - Phone
- (224) 656-7014
- NPI assigned
- Apr 30, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002369A | IN | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36002369A | IN | Yes |
Addresses
Primary practice location
2051 E Commercial Ave
Lowell, IN 46356-2115
Mailing address
12800 Mississippi Pkwy
Crown Point, IN 46307-6900
Other providers in Lowell, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.