Provider Demographics
NPI:1558343731
Name:DENNIS, MARIA NICOLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NICOLE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:NICOLE
Other - Last Name:MONNIKENDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4154
Mailing Address - Country:US
Mailing Address - Phone:814-941-7708
Mailing Address - Fax:814-941-7715
Practice Address - Street 1:105 NASON DR
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1202
Practice Address - Country:US
Practice Address - Phone:814-224-6214
Practice Address - Fax:814-224-6240
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1749703OtherHIGHMARK
PA1749703OtherHIGHMARK