Basic Information
| Provider Information | |||||||||
| NPI: | 1851440408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTEMAYOR | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | FAJARDO | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8500 BLUFFSTONE CV STE A201 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787597846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009674667 | ||||||||
| FaxNumber: | 8009672382 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 TOWN CENTER WEST WAY | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957627575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169997230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 29186 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.