Provider Demographics
NPI:1508599341
Name:MONROE, ANDREAS C (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:C
Last Name:MONROE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W OAKLAND PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7268
Mailing Address - Country:US
Mailing Address - Phone:954-735-5353
Mailing Address - Fax:
Practice Address - Street 1:4850 W OAKLAND PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7268
Practice Address - Country:US
Practice Address - Phone:954-735-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT38604OtherMEDICAL LICENSE