Individual provider Active NPI

Montana Van Ho, DPT, DOM

  • Physical Therapist
  • Lake Mary, FL
National Provider Identifier
1053703165
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT29612 Issued in FL
Practice address
245 Wheelhouse LN Ste 1451
Lake Mary, FL 32746-3696
Phone
(407) 878-0507
Fax
(844) 904-0880
NPI assigned
Feb 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AP3608 FL
Physical Therapist 225100000X PT29612 FL Primary

Addresses

Primary practice location

245 Wheelhouse LN Ste 1451
Lake Mary, FL 32746-3696

Mailing address

245 Wheelhouse LN Ste 1451
Lake Mary, FL 32746-3696
Phone (407) 878-0507

Other identifiers 2

IdentifierTypeStateIssuer
AP3608OtherFLSTATE LICENSE
PT29612OtherFLSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160428000962 FL Practitioner - Physical Therapist in Private Practice 6204135056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

245 Wheelhouse LN
Suite 1451
Lake Mary, FL 32746-3696
Phone (407) 878-0507

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP3608FLMDAcupuncturist
PT29612FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Acuphysio360, LLC Acupuncturist CurrentSince Mar 8, 2020 Accepting new patients

Locations

245 Wheelhouse Ln
Ste 1451
Lake Mary, FL 32746
Phone (407) 878-0507

245 Wheelhouse Ln
Lake Mary, FL 32746
Phone (407) 878-0507

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1053703165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 WHEELHOUSE LN STE 1451",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463696",
            "telephone_number": "407-878-0507",
            "fax_number": "844-904-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 WHEELHOUSE LN STE 1451",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463696",
            "telephone_number": "407-878-0507",
            "fax_number": "844-904-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HO",
        "first_name": "MONTANA",
        "middle_name": "VAN",
        "credential": "DPT, DOM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-26",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "AP3608",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT29612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AP3608",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT29612",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.