MEDICARE: KRISTOFFER PETERSEN MONZON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT26704	CA

General Provider Information

NPI Number	:	1609851781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOFFER PETERSEN MONZON PT

Provider Business Mailing Address
First Line	:	16615 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-2046
Country	:	US
Telephone Number	:	714-577-0745
Fax Number	:	714-577-8653

Provider Business Practice Location Address
First Line	:	16615 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-2046
Country	:	US
Telephone Number	:	714-577-0745
Fax Number	:	714-577-8653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	10/08/2012

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