Provider Demographics
NPI:1457476152
Name:ROSSON, MONICA J (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:ROSSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 NIGHTHAWK RD
Mailing Address - Street 2:P.O. BOX 1100
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-7532
Mailing Address - Country:US
Mailing Address - Phone:417-312-0189
Mailing Address - Fax:
Practice Address - Street 1:2810 N SWAN ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5853
Practice Address - Country:US
Practice Address - Phone:505-956-2000
Practice Address - Fax:505-956-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022732225100000X
NM3370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist