1336262716 NPI number — NANCY P. MONNIE, PC

Table of content: (NPI 1336262716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336262716 NPI number — NANCY P. MONNIE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY P. MONNIE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANDY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336262716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16621 CHAMPION WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97055-7257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-668-5321
Provider Business Mailing Address Fax Number:
503-668-9742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16621 CHAMPION WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97055-7257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-668-5321
Provider Business Practice Location Address Fax Number:
503-668-9742
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONNIE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
PENROD
Authorized Official Title or Position:
OWNER, MANAGER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
503-668-5321

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1094 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 071787 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0206612 . This is a "WASHINGTON LABOR & INDUST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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