Provider Demographics
NPI:1043423932
Name:HOWARD, MONIQUE M (MPT)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32015 WATERSIDE LANE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-815-2807
Mailing Address - Fax:
Practice Address - Street 1:141 TRIUNFO CYN ROAD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-2525
Practice Address - Country:US
Practice Address - Phone:805-373-6560
Practice Address - Fax:805-373-5120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103049OtherMEDICARE PROVIDER ID NUM