Active NPI
Michael Wayne Montgomery, MA, ATC, LAT, LMT
- Massage Therapist
- Bardstown, KY
National Provider Identifier
1689643116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 106160
- Practice address
- 102 Crystal Springs Dr
Bardstown, KY 40004-8203 - Phone
- (502) 460-4557
- NPI assigned
- Mar 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36000895A | IN | |
| Massage Therapist | 225700000X | 106160 | KY | Primary |
Addresses
Primary practice location
102 Crystal Springs Dr
Bardstown, KY 40004-8203
Mailing address
102 Crystal Springs Dr
Bardstown, KY 40004-8203
Phone (502) 460-4557
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36000895A | IN | MD | Athletic Trainer |
| 106160 | KY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735516800000",
"number": "1689643116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 CRYSTAL SPRINGS DR",
"city": "BARDSTOWN",
"state": "KY",
"postal_code": "400048203",
"telephone_number": "502-460-4557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 CRYSTAL SPRINGS DR",
"city": "BARDSTOWN",
"state": "KY",
"postal_code": "400048203",
"telephone_number": "502-460-4557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"credential": "MA, ATC, LAT, LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-16",
"last_updated": "2024-12-30",
"certification_date": "2024-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36000895A",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "KY",
"license": "106160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bardstown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.