Provider Demographics
NPI:1568518454
Name:MONIZ, KATHLEEN M (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MONIZ
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 1:93 OLD MAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2704
Mailing Address - Country:US
Mailing Address - Phone:508-564-5620
Mailing Address - Fax:508-564-5620
Practice Address - Street 1:93 OLD MAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2704
Practice Address - Country:US
Practice Address - Phone:508-564-5620
Practice Address - Fax:508-564-5620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA411780OtherTUFTS HEALTH PLAN
MA411780OtherU. S. FAMILY HEALTH SERVI
MA0319350Medicaid
MA37063OtherHARVARD PILGRIM
MA029400299OtherTRICARE
MAY666196OtherBLUE CROSS BLUE SHIELD MA
MA411780OtherSECURE HORIZONS
MA411780OtherSECURE HORIZONS