Provider Demographics
NPI:1013223254
Name:MONACO, RICHARD L (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:MONACO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PL
Mailing Address - Street 2:SUITE 50
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1696
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-745-8872
Practice Address - Street 1:1604 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5619
Practice Address - Country:US
Practice Address - Phone:719-630-3193
Practice Address - Fax:719-630-3195
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist