Provider Demographics
NPI:1407955164
Name:WHITAKER, MONICA JOANN (PTA, ATC)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JOANN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 ANDREW CT
Mailing Address - Street 2:APT 201
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2363
Mailing Address - Country:US
Mailing Address - Phone:301-604-5446
Mailing Address - Fax:410-590-4365
Practice Address - Street 1:8131 RITCHIE HWY
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6940
Practice Address - Country:US
Practice Address - Phone:410-590-4360
Practice Address - Fax:410-590-4365
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2986225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant