Provider Demographics
NPI:1750716163
Name:COLAMATTEO, MONICA TYANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:TYANNE
Last Name:COLAMATTEO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RONZHEIMER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4583
Mailing Address - Country:US
Mailing Address - Phone:630-973-3246
Mailing Address - Fax:
Practice Address - Street 1:1701 RONZHEIMER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4583
Practice Address - Country:US
Practice Address - Phone:630-973-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004945225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant