Provider Demographics
NPI:1467054668
Name:RESCO, MONIQUE (CPTA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:RESCO
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:KS
Mailing Address - Zip Code:66938-9505
Mailing Address - Country:US
Mailing Address - Phone:785-614-1379
Mailing Address - Fax:
Practice Address - Street 1:631 E CRAWFORD ST STE 220
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5116
Practice Address - Country:US
Practice Address - Phone:785-825-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03768225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant