Provider Demographics
NPI:1811010556
Name:PREROVSKY, MONICA (MPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PREROVSKY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10141
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-6141
Mailing Address - Country:US
Mailing Address - Phone:505-577-3326
Mailing Address - Fax:505-988-7187
Practice Address - Street 1:4671 SAN YSIDRO PL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3485
Practice Address - Country:US
Practice Address - Phone:505-577-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist