Provider Demographics
NPI:1649759234
Name:MONROE, DELESA (PT, DPT, NCS)
Entity Type:Individual
Prefix:
First Name:DELESA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 MILLA CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3905
Mailing Address - Country:US
Mailing Address - Phone:325-214-0163
Mailing Address - Fax:
Practice Address - Street 1:5608 PARKCREST DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4972
Practice Address - Country:US
Practice Address - Phone:325-214-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1248171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1248171OtherPT LICENSE NUMBER