Provider Demographics
NPI:1780668806
Name:SCHUTT, MONICA LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LYNN
Last Name:SCHUTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9419 COPPERTOP LOOP NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3647
Mailing Address - Country:US
Mailing Address - Phone:206-842-2428
Mailing Address - Fax:206-842-2890
Practice Address - Street 1:9419 COPPERTOP LOOP NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3647
Practice Address - Country:US
Practice Address - Phone:206-842-2428
Practice Address - Fax:206-842-2890
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29402225100000X
HIPT3303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206907OtherWA DEPT OF LABOR
CAWPT29402AOtherMEDICARE PTAN