Provider Demographics
NPI:1710084512
Name:MONACO, TRACY L (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:MONACO
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 1:115 1/2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-2514
Mailing Address - Country:US
Mailing Address - Phone:908-730-0591
Mailing Address - Fax:
Practice Address - Street 1:1 EAST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3075
Practice Address - Country:US
Practice Address - Phone:908-730-6640
Practice Address - Fax:908-730-0468
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist