Provider Demographics
NPI:1295860849
Name:MOORE, MONICA J (MPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:MOORE
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 1:5834 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1409
Mailing Address - Country:US
Mailing Address - Phone:773-575-7396
Mailing Address - Fax:773-257-9129
Practice Address - Street 1:5834 W OHIO ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1409
Practice Address - Country:US
Practice Address - Phone:773-575-7396
Practice Address - Fax:773-257-9129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist