Provider Demographics
NPI:1295365146
Name:PATHAK, MONIKA (PT)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:PATHAK
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 1:5656 S POWER RD STE 139
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8490
Mailing Address - Country:US
Mailing Address - Phone:480-272-7797
Mailing Address - Fax:480-704-3903
Practice Address - Street 1:1917 S SIGNAL BUTTE RD STE B106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2602
Practice Address - Country:US
Practice Address - Phone:480-272-7797
Practice Address - Fax:480-704-3903
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist