Provider Demographics
NPI:1912970898
Name:MOKHA, GEORGIA MONIQUE (PHD ATC)
Entity Type:Individual
Prefix:PROF
First Name:GEORGIA
Middle Name:MONIQUE
Last Name:MOKHA
Suffix:
Gender:F
Credentials:PHD ATC
Other - Prefix:PROF
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:BUTCHER-MOKHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD ATC
Mailing Address - Street 1:95 S SHORE DR
Mailing Address - Street 2:#2
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11300 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33161-6628
Practice Address - Country:US
Practice Address - Phone:305-899-3555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 8952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer