Individual provider Active NPI

Kyle Adrian Montgomery, M.S., A.T.C.

  • Athletic Trainer
  • Clearwater, FL
National Provider Identifier
1053732776
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AL3594 Issued in FL
Practice address
2761 Sea Pines Cir E
Clearwater, FL 33761-3008
Phone
(727) 515-0214
NPI assigned
Dec 23, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AL3594 FL Primary

Addresses

Primary practice location

2761 Sea Pines Cir E
Clearwater, FL 33761-3008

Mailing address

2761 Sea Pines Cir E
Clearwater, FL 33761-3008
Phone (727) 515-0214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
AL3594FLMDAthletic Trainer

NPI Registry JSON

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

{
    "created_epoch": "1387756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387756800000",
    "number": "1053732776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2761 SEA PINES CIR E",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337613008",
            "telephone_number": "727-515-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2761 SEA PINES CIR E",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337613008",
            "telephone_number": "727-515-0214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "KYLE",
        "middle_name": "ADRIAN",
        "credential": "M.S., A.T.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-23",
        "last_updated": "2013-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; 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.