Provider Demographics
NPI:1922241819
Name:MONGE, MARLA (LMT)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:MONGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 S MULFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3009
Mailing Address - Country:US
Mailing Address - Phone:815-227-9997
Mailing Address - Fax:815-227-9929
Practice Address - Street 1:421 S MULFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3009
Practice Address - Country:US
Practice Address - Phone:815-227-9997
Practice Address - Fax:815-227-9929
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist