Provider Demographics
NPI:1659919793
Name:YOON, MONICA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 WAVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2309
Mailing Address - Country:US
Mailing Address - Phone:302-753-1352
Mailing Address - Fax:
Practice Address - Street 1:1602 WAVERLY WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2309
Practice Address - Country:US
Practice Address - Phone:302-753-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5224208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation