Provider Demographics
NPI:1669849337
Name:MONAGHAN, PATRICK (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MONAGHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MANSELL CT E
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4821
Mailing Address - Country:US
Mailing Address - Phone:770-992-4001
Mailing Address - Fax:770-992-4095
Practice Address - Street 1:20 MANSELL CT E
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4821
Practice Address - Country:US
Practice Address - Phone:770-992-4001
Practice Address - Fax:770-992-4095
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0121232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic