Provider Demographics
NPI:1609851781
Name:MONZON, KRISTOFFER PETERSEN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:PETERSEN
Last Name:MONZON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2046
Mailing Address - Country:US
Mailing Address - Phone:714-577-0745
Mailing Address - Fax:714-577-8653
Practice Address - Street 1:16615 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2046
Practice Address - Country:US
Practice Address - Phone:714-577-0745
Practice Address - Fax:714-577-8653
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN198ZMedicare UPIN