Provider Demographics
NPI:1396260386
Name:MONACO, JENNIFER CATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:MONACO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 NE AMBASSADOR PL STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1379
Mailing Address - Country:US
Mailing Address - Phone:503-261-8599
Mailing Address - Fax:503-408-8932
Practice Address - Street 1:7515 NE AMBASSADOR PL STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1379
Practice Address - Country:US
Practice Address - Phone:503-261-8599
Practice Address - Fax:503-408-8932
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60771908225100000X
MTPTP-PT-LIC-17080225100000X
OR62286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist