Provider Demographics
NPI:1407160930
Name:EVANS, MONICA LEE (MPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LEE
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:30141 ANTELOPE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7001
Practice Address - Country:US
Practice Address - Phone:951-723-1866
Practice Address - Fax:951-723-1867
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12188249OtherCAQH
CA12188249OtherCAQH