Provider Demographics
NPI:1760125777
Name:MONROE, MIGUEL XAVIER (PTA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:XAVIER
Last Name:MONROE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 FOUNDRY WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5885
Mailing Address - Country:US
Mailing Address - Phone:757-876-0485
Mailing Address - Fax:
Practice Address - Street 1:10750 COLUMBIA PIKE STE 310
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4453
Practice Address - Country:US
Practice Address - Phone:301-658-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605894225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant