Provider Demographics
NPI:1851406557
Name:MONGIANO, PATRICIA A (RPT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MONGIANO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42220 10TH ST W
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7075
Mailing Address - Country:US
Mailing Address - Phone:661-729-4231
Mailing Address - Fax:661-940-3041
Practice Address - Street 1:42220 10TH ST W
Practice Address - Street 2:SUITE 109
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7075
Practice Address - Country:US
Practice Address - Phone:661-729-4231
Practice Address - Fax:661-940-3041
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 16857Medicare ID - Type Unspecified