Provider Demographics
NPI:1508190828
Name:MCILVAIN, MONICA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:MCILVAIN
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 1:4411 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3313
Mailing Address - Country:US
Mailing Address - Phone:512-328-8934
Mailing Address - Fax:512-328-8953
Practice Address - Street 1:4411 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3313
Practice Address - Country:US
Practice Address - Phone:512-328-8934
Practice Address - Fax:512-328-8953
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist