Provider Demographics
NPI:1447757422
Name:BLACK, MONICA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:BLACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5821
Mailing Address - Country:US
Mailing Address - Phone:760-452-2640
Mailing Address - Fax:760-994-4641
Practice Address - Street 1:227 N EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5821
Practice Address - Country:US
Practice Address - Phone:760-452-2640
Practice Address - Fax:760-994-4641
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist