Provider Demographics
NPI:1568510147
Name:PEDDYCORD, MONIKA MARIA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:MARIA
Last Name:PEDDYCORD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46591 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5742
Mailing Address - Country:US
Mailing Address - Phone:586-226-6500
Mailing Address - Fax:586-226-6505
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:SUITE 115
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6500
Practice Address - Fax:586-226-6505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL930414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist