Provider Demographics
NPI:1518083849
Name:MONTY, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MONTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210721
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-0721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9109 MENDENHALL MALL RD
Practice Address - Street 2:SUITE 5K
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7113
Practice Address - Country:US
Practice Address - Phone:907-209-8571
Practice Address - Fax:907-586-6736
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT06932Medicaid