Provider Demographics
NPI:1346029931
Name:SRIVASTAV, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SRIVASTAV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GRANITE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-3821
Mailing Address - Country:US
Mailing Address - Phone:908-589-2467
Mailing Address - Fax:
Practice Address - Street 1:535 GRADYVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2812
Practice Address - Country:US
Practice Address - Phone:908-589-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0196842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics