Provider Demographics
NPI:1740557651
Name:MONARCH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MONARCH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:830-431-0773
Mailing Address - Street 1:926 E BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1710
Mailing Address - Country:US
Mailing Address - Phone:830-431-0773
Mailing Address - Fax:830-265-4053
Practice Address - Street 1:926 E BLANCO RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1710
Practice Address - Country:US
Practice Address - Phone:830-431-0773
Practice Address - Fax:830-265-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115111261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871517714OtherINDIVIDUAL NPI