Provider Demographics
NPI:1558793984
Name:DE FREITAS, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 BROMPTON ST
Mailing Address - Street 2:APT 239
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2990 LAUREL ST
Practice Address - Street 2:SUITE A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-2104
Practice Address - Country:US
Practice Address - Phone:409-982-8878
Practice Address - Fax:409-982-5119
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3114363225100000X
TX1242616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist