Provider Demographics
NPI:1285865444
Name:O'ROURKE, MONICA A (DPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DUKE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3357
Mailing Address - Country:US
Mailing Address - Phone:703-535-5491
Mailing Address - Fax:703-786-3352
Practice Address - Street 1:1501 DUKE ST STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3357
Practice Address - Country:US
Practice Address - Phone:703-535-5491
Practice Address - Fax:703-786-3352
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031608225100000X
VA2305206105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305206105OtherVA PT LICENSE