Avanleigh Montgomery, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

191274 Issued in AK

Practice address

613 S Knik Goose Bay Rd Ste E
Wasilla, AK 99654-8090

Phone

(907) 317-5895

NPI assigned

Jun 17, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1033840350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 46TH STREET CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984666658",
            "telephone_number": "253-509-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 S KNIK GOOSE BAY RD STE E",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548090",
            "telephone_number": "907-317-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "AVANLEIGH",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "60975822",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AK",
            "license": "191274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Rose Monette, DPT, PT
• Jessica Corinne Monroe
• Jill Marie Monroe, LMT
• Janette Rene Montague
• Michael Montano, M.D.
• Joshua Montgomery, DMD
• Amy A Moore
• Anna Moore, OTR/L
• Darrell Moore
• Jennifer Moore

• Physical Therapy Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physical Therapy Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.