Provider Demographics
NPI:1205973716
Name:MYERS, MONIQUE ADRIANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ADRIANNA
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:ADRIANNA
Other - Last Name:PERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1267 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1702
Practice Address - Country:US
Practice Address - Phone:610-941-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870288225100000X
MD20661225100000X
PAPT020266225100000X
DEJ1-0002596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist