Provider Demographics
NPI:1992177919
Name:MONROE, DANA J (PTA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:MONROE
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 1:10701 NALL AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1244
Mailing Address - Country:US
Mailing Address - Phone:913-663-2634
Mailing Address - Fax:
Practice Address - Street 1:10701 NALL AVE STE 130
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1244
Practice Address - Country:US
Practice Address - Phone:913-663-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant