Provider Demographics
NPI:1821321092
Name:BECK, MONLO RONDON (DPT)
Entity Type:Individual
Prefix:
First Name:MONLO
Middle Name:RONDON
Last Name:BECK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 N CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5500
Mailing Address - Country:US
Mailing Address - Phone:208-934-8766
Mailing Address - Fax:208-934-4639
Practice Address - Street 1:267 N CANYON DR
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-5500
Practice Address - Country:US
Practice Address - Phone:208-934-8766
Practice Address - Fax:208-934-4639
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist