Provider Demographics
NPI:1003832759
Name:RODOLPHE, MONIQUE T (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:T
Last Name:RODOLPHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 N OLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3105
Mailing Address - Country:US
Mailing Address - Phone:609-530-0011
Mailing Address - Fax:609-530-0666
Practice Address - Street 1:1881 N OLDEN AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3105
Practice Address - Country:US
Practice Address - Phone:609-530-0011
Practice Address - Fax:609-530-0666
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01108000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084262TAPMedicare ID - Type Unspecified