Provider Demographics
NPI:1578033874
Name:COFINO, MONIQUE (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:COFINO
Suffix:
Gender:F
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HEMBREE RD UNIT 215
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2091
Mailing Address - Country:US
Mailing Address - Phone:470-231-6556
Mailing Address - Fax:
Practice Address - Street 1:1401 JOHNSON FERRY RD STE 340
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6495
Practice Address - Country:US
Practice Address - Phone:404-491-7420
Practice Address - Fax:404-491-7421
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist