Provider Demographics
NPI:1295949097
Name:DICKINSON, MONIQUE MARIE KNOROSKI (RKT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE KNOROSKI
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 POE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1807
Mailing Address - Country:US
Mailing Address - Phone:619-795-3604
Mailing Address - Fax:
Practice Address - Street 1:3568 POE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1807
Practice Address - Country:US
Practice Address - Phone:619-795-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist