Provider Demographics
NPI:1225042013
Name:MONSON, EMILY J (MSPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:MONSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005-0147
Mailing Address - Country:US
Mailing Address - Phone:715-263-4103
Mailing Address - Fax:715-263-4110
Practice Address - Street 1:417 3RD AVE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:WI
Practice Address - Zip Code:54005
Practice Address - Country:US
Practice Address - Phone:715-263-4103
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9552024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40455100Medicaid
WI000380050Medicare ID - Type Unspecified
WI40455100Medicaid
P00857784Medicare PIN
WIWI1422001Medicare PIN
WIP00347215Medicare UPIN