Provider Demographics
NPI:1952070948
Name:MOORE, MONICA DOROTHY (PTA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DOROTHY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3176
Mailing Address - Country:US
Mailing Address - Phone:703-837-0010
Mailing Address - Fax:
Practice Address - Street 1:127 N WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3176
Practice Address - Country:US
Practice Address - Phone:703-837-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant