Provider Demographics
NPI:1821564683
Name:LOARES, MONICA ANN (PT)
Entity Type:Individual
Prefix:
First Name:MONICA ANN
Middle Name:
Last Name:LOARES
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 1:58 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2602
Mailing Address - Country:US
Mailing Address - Phone:502-930-7638
Mailing Address - Fax:
Practice Address - Street 1:799 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3604
Practice Address - Country:US
Practice Address - Phone:718-684-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043661-1225100000X
NC16159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist