Provider Demographics
NPI:1447521216
Name:MONTALVO, GINA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PINE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-5753
Mailing Address - Country:US
Mailing Address - Phone:914-388-9694
Mailing Address - Fax:
Practice Address - Street 1:28 PINE RIDGE LN
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5753
Practice Address - Country:US
Practice Address - Phone:914-388-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023410-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist