Provider Demographics
NPI:1477833747
Name:FLEMINGS, MONIQUE (PT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:FLEMINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:MADLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1940
Mailing Address - Fax:
Practice Address - Street 1:17045 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1014
Practice Address - Country:US
Practice Address - Phone:708-418-3580
Practice Address - Fax:708-418-3931
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist